Healthcare Provider Details

I. General information

NPI: 1831544089
Provider Name (Legal Business Name): SUHAIB ASED D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE CAMC GME OFFICE
CHARLESTON WV
25304-1210
US

IV. Provider business mailing address

3110 MACCORKLE AVE SE CAMC GME OFFICE
CHARLESTON WV
25304-1210
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7170
  • Fax: 304-388-6597
Mailing address:
  • Phone: 304-388-7170
  • Fax: 304-488-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3443
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2020012894
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: