Basic Information
| Provider Information | |||||||||
| NPI: | 1184757163 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NAEEM PERVAIZ, M.D., P.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 608 NEW HOPE RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044251522 | ||||||||
| FaxNumber: | 3044879447 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 NEW HOPE RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044251522 | ||||||||
| FaxNumber: | 3044879447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 07/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | PERVAIZ | ||||||||
| AuthorizedOfficialFirstName: | NAEEM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3044251522 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 406343640 | 01 | WV | RAILROAD MEDICARE | OTHER | 0130715000 | 05 | WV | MEDICAID |