Provider Demographics
NPI:1982622825
Name:HEGAB, IBRAHIM MOHAMED (MD)
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:MOHAMED
Last Name:HEGAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71078
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23255-1078
Mailing Address - Country:US
Mailing Address - Phone:804-353-0023
Mailing Address - Fax:804-353-0773
Practice Address - Street 1:7660 E PARHAM RD
Practice Address - Street 2:STE 208
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4378
Practice Address - Country:US
Practice Address - Phone:804-353-0023
Practice Address - Fax:804-353-0073
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012403072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010312914Medicaid
VAI67601Medicare UPIN