Basic Information
Provider Information | |||||||||
NPI: | 1558309187 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAMAL | ||||||||
FirstName: | MALIHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1112 | ||||||||
Address2: | 1322 LOCUST AVE | ||||||||
City: | FAIRMONT | ||||||||
State: | WV | ||||||||
PostalCode: | 26554 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3043660700 | ||||||||
FaxNumber: | 3043669529 | ||||||||
Practice Location | |||||||||
Address1: | 1322 LOCUST AVE | ||||||||
Address2: |   | ||||||||
City: | FAIRMONT | ||||||||
State: | WV | ||||||||
PostalCode: | 26554 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3043660700 | ||||||||
FaxNumber: | 3043669529 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/04/2006 | ||||||||
LastUpdateDate: | 06/21/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21917 | WV | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 407115 | 01 | WV | CARELINK | OTHER | I44819 | 01 | WV | WV WORKER'S COMP | OTHER | P00269249 | 01 | WV | RR MEDICARE | OTHER | 001771616 | 01 | WV | MT STATE BC/BS | OTHER | FQ21917 | 01 | WV | HEALTH PLAN | OTHER | 1558309187 | 01 | WV | OHIO WORKER'S COMP | OTHER | 3810003484 | 05 | WV |   | MEDICAID |