Healthcare Provider Details

I. General information

NPI: 1881895100
Provider Name (Legal Business Name): APPALACHIAN GASTROENTEROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 CARRIAGE DR
BECKLEY WV
25801-2805
US

IV. Provider business mailing address

P.O. BOX 1189
BECKLEY WV
25802
US

V. Phone/Fax

Practice location:
  • Phone: 304-253-0849
  • Fax: 304-253-1573
Mailing address:
  • Phone: 304-253-0849
  • Fax: 304-253-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number13335
License Number StateWV

VIII. Authorized Official

Name: DR. HUSAM MOHAMMAD NAZER
Title or Position: OWNER
Credential: M.D.,FACP,FACG
Phone: 304-253-0849