Healthcare Provider Details

I. General information

NPI: 1740474329
Provider Name (Legal Business Name): SAMINA KAZMI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS ST STE 403
CHARLESTON WV
25301-1854
US

IV. Provider business mailing address

415 MORRIS ST STE 403
CHARLESTON WV
25301-1854
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0166
  • Fax: 304-344-5105
Mailing address:
  • Phone: 304-344-0166
  • Fax: 304-344-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number20887
License Number StateWV

VIII. Authorized Official

Name: MR. SYED G KAZMI
Title or Position: MANAGER
Credential:
Phone: 304-344-0166