Healthcare Provider Details

I. General information

NPI: 1689670069
Provider Name (Legal Business Name): AHMAD BALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S RUFFNER RD STE 2
CHARLESTON WV
25314-1542
US

IV. Provider business mailing address

400 S RUFFNER RD STE 2
CHARLESTON WV
25314-1542
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-2254
  • Fax: 304-346-3184
Mailing address:
  • Phone: 304-346-2254
  • Fax: 304-346-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21044
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number21044
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: