Healthcare Provider Details

I. General information

NPI: 1649356866
Provider Name (Legal Business Name): AHMED DAVER FAHEEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 JOHNSTOWN ROAD
BECKLEY WV
25801-4940
US

IV. Provider business mailing address

PO BOX 1128 1014 JOHNSTOWN ROAD
BECKLEY WV
25802-1128
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-4433
  • Fax: 304-252-1703
Mailing address:
  • Phone: 304-252-4433
  • Fax: 304-252-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12885
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number12885
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number12885
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number12885
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: