Healthcare Provider Details

I. General information

NPI: 1073995577
Provider Name (Legal Business Name): SAID HAJOULI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 03/16/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 101
CHARLESTON WV
25304-1215
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 101
CHARLESTON WV
25304-1215
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-8200
  • Fax: 304-388-7087
Mailing address:
  • Phone: 43-388-8200
  • Fax: 304-388-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28317
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: