Healthcare Provider Details

I. General information

NPI: 1689644676
Provider Name (Legal Business Name): AHMAD NUSAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 15TH ST SUITE 3000
HUNTINGTON WV
25701-3662
US

IV. Provider business mailing address

1249 15TH ST SUITE 3000
HUNTINGTON WV
25701-3662
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1000
  • Fax: 304-691-1693
Mailing address:
  • Phone: 304-691-1000
  • Fax: 304-691-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22818
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number22818
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number53430
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number22818
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: