Basic Information
| Provider Information | |||||||||
| NPI: | 1376629592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYED | ||||||||
| FirstName: | SAFIULLAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1128 | ||||||||
| Address2: | 1014 JOHNSTOWN ROAD | ||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258011128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042524433 | ||||||||
| FaxNumber: | 3042521703 | ||||||||
| Practice Location | |||||||||
| Address1: | 1014 JOHNSTOWN ROAD | ||||||||
| Address2: | |||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258014940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042524433 | ||||||||
| FaxNumber: | 3042521703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 08/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 19588 | WV | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 001709973 | 01 | WV | BCBS | OTHER | 0280016000 | 05 | WV | MEDICAID | AP9290091 | 01 | WV | RR MEDICARE | OTHER |