Provider Demographics
NPI:1053540369
Name:ESHAFI, KOUROSH (MD)
Entity type:Individual
Prefix:DR
First Name:KOUROSH
Middle Name:
Last Name:ESHAFI
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 1:825 FAIRFAX
Mailing Address - Street 2:EVMS GHENT FAMILY MEDICINE
Mailing Address - City:NORFOLK
Mailing Address - State:VI
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-446-5738
Mailing Address - Fax:757-446-8450
Practice Address - Street 1:825 FAIRFAX AVE.
Practice Address - Street 2:EVMS GHENT FAMILY MEDICINE
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-446-5738
Practice Address - Fax:757-446-8450
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116021212390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program