Basic Information
| Provider Information | |||||||||
| NPI: | 1689849630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIN | ||||||||
| FirstName: | KALEEM-UD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | 5 E ALVON ROAD, SUITE 7 | ||||||||
| City: | WHITE SULPHUR SPRINGS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249862373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045365030 | ||||||||
| FaxNumber: | 3045365051 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ARH LANE | ||||||||
| Address2: | |||||||||
| City: | LOW MOOR | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408626011 | ||||||||
| FaxNumber: | 5408626472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101243350 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3810012419 | 05 | WV | MEDICAID | 9411155 | 01 | VA | AETNA | OTHER | 100452602 | 01 | WV | DEPT OF LABOR | OTHER | 1073729 | 01 | WV | WV COMPENSATION | OTHER | 2058507 | 01 | WV | MOUNTAIN ST BCBS | OTHER |