| NPI | 1417079229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMMAD ANWAR ULLAH Physician Manager 304-465-5066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2020-08-22 |