Basic Information
| Provider Information | |||||||||
| NPI: | 1679573299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWLAH | ||||||||
| FirstName: | ZUBAER | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 MINERAL RD | ||||||||
| Address2: | |||||||||
| City: | GLENVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263511385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044627322 | ||||||||
| FaxNumber: | 3044624052 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 MINERAL RD | ||||||||
| Address2: | GILMER PRIMARY CARE A DEPT. OF MHHCC | ||||||||
| City: | GLENVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263511385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044627322 | ||||||||
| FaxNumber: | 3044624052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 04/09/2008 | ||||||||
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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 | 207R00000X | 18726 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | M4025 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8U3495 | 01 | TX | BCBS | OTHER | 6000949000 | 05 | WV | MEDICAID |