Healthcare Provider Details

I. General information

NPI: 1417079229
Provider Name (Legal Business Name): DOCTORS EXPRESS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 B STANAFORD RD
BECKLEY WV
25802
US

IV. Provider business mailing address

PO BOX 963 269 B STANAFORD RD
BECKLEY WV
25802
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-5066
  • Fax: 304-465-5066
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOHAMMAD ANWAR ULLAH
Title or Position: PHYSICIAN MANAGER
Credential: MD
Phone: 304-465-5066