Healthcare Provider Details

I. General information

NPI: 1326493362
Provider Name (Legal Business Name): YASIR JAWAID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 15TH ST SUITE 2000
HUNTINGTON WV
25701-3662
US

IV. Provider business mailing address

1249 15TH ST SUITE 2000
HUNTINGTON WV
25701-3662
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD04072
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: