Healthcare Provider Details

I. General information

NPI: 1124682158
Provider Name (Legal Business Name): ALI RAIED SALMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 LAIDLEY ST STE 301
CHARLESTON WV
25301-1605
US

IV. Provider business mailing address

331 LAIDLEY ST STE 301
CHARLESTON WV
25301-1605
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-4400
  • Fax: 304-346-0704
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number36405
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberD0103123
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number18814
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD600003650
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberEMC0009476
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number36405
License Number StateWV
# 7
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0103123
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD-57572
License Number StateIA
# 9
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101285540
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: