Basic Information
| Provider Information | |||||||||
| NPI: | 1679731467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SRAJ | ||||||||
| FirstName: | SHAFIC | ||||||||
| MiddleName: | ABDULLAH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 177 MIDDLETOWN RD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | FAIRMONT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265548254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045984830 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29 HOSPITAL PLZ | ||||||||
| Address2: | STE C | ||||||||
| City: | WESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 264528470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044068993 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2008 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | 24178 | WV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XX0005X | 24178 | WV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | 24178 | WV | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.