Healthcare Provider Details

I. General information

NPI: 1740599919
Provider Name (Legal Business Name): AMJAD MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N EISENHOWER DR
BECKLEY WV
25801
US

IV. Provider business mailing address

330 N EISENHOWER DR
BECKLEY WV
25801
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-5900
  • Fax: 604-252-5915
Mailing address:
  • Phone: 304-252-5900
  • Fax: 604-252-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number24182
License Number StateWV

VIII. Authorized Official

Name: DR. QUARTEL-AYNE AMJAD
Title or Position: OWNER
Credential: MD
Phone: 304-252-5900