Provider Demographics
NPI:1992774202
Name:BAKSH, MASUD REZA QUADIR (MD)
Entity type:Individual
Prefix:DR
First Name:MASUD
Middle Name:REZA QUADIR
Last Name:BAKSH
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:502 W BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3206
Practice Address - Country:US
Practice Address - Phone:252-209-3148
Practice Address - Fax:252-209-3146
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000715207P00000X
VA0101226382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127M6Medicaid
NC127M6OtherBCBS OF NC
NCD7889OtherMEDCOST
NC127M6OtherBCBS OF NC
NC89127M6Medicaid