Healthcare Provider Details

I. General information

NPI: 1699867598
Provider Name (Legal Business Name): ALI F ABURAHMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE FL 4
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

PO BOX 7000
MORGANTOWN WV
26507-7000
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5590
  • Fax: 304-388-8238
Mailing address:
  • Phone: 304-347-1290
  • Fax: 304-347-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number10516
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: