Healthcare Provider Details

I. General information

NPI: 1174616668
Provider Name (Legal Business Name): FAROUG YASSIN MOHMD SULIMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS ST STE 100
CHARLESTON WV
25301-1840
US

IV. Provider business mailing address

415 MORRIS ST STE 100
CHARLESTON WV
25301-1840
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7823
  • Fax:
Mailing address:
  • Phone: 304-388-7823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33201
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLT10348
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37498
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301115017
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number33201
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301115017
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number10348
License Number StateND
# 8
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberLT10348
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: