Basic Information
| Provider Information | |||||||||
| NPI: | 1568687606 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NAEEM A QAZI MD FACC PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 SOUTHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247014320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043258171 | ||||||||
| FaxNumber: | 3043253914 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 SOUTHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | BLUEFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247014320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043258171 | ||||||||
| FaxNumber: | 3043253914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 01/08/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | QAZI | ||||||||
| AuthorizedOfficialFirstName: | NAEEM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3043258171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NAEEM A QAZI MD FACC PC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | C06159 | 05 | VA | MEDICAID | 3810002520 | 05 | WV | MEDICAID |