Healthcare Provider Details

I. General information

NPI: 1225031701
Provider Name (Legal Business Name): RIAD AL-ASBAHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 QUARRIER ST STE 301
CHARLESTON WV
25301-2313
US

IV. Provider business mailing address

1021 QUARRIER ST STE 301
CHARLESTON WV
25301-2313
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-4625
  • Fax: 304-343-4626
Mailing address:
  • Phone: 304-343-4625
  • Fax: 304-343-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12100
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: