Healthcare Provider Details

I. General information

NPI: 1710417704
Provider Name (Legal Business Name): AMMAD NAEEM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE B-16
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

2157 MAIN STREET, 5TH FLOOR DEPARTMENT OF MEDICINE YVONNE MCPHAIL DOLL, PROGRAM ADMINISTRATOR SISTERS OF C
BUFFALO NY
14214
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5848
  • Fax:
Mailing address:
  • Phone: 716-862-1423
  • Fax: 716-862-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29605
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: