Healthcare Provider Details

I. General information

NPI: 1386836401
Provider Name (Legal Business Name): NADIM LOUIS BOU ZGHEIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HAL GREER BLVD
HUNTINGTON WV
25701-4114
US

IV. Provider business mailing address

1400 HAL GREER BLVD
HUNTINGTON WV
25701-4114
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-6556
  • Fax: 304-399-6554
Mailing address:
  • Phone: 304-399-6556
  • Fax: 304-399-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT191194
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME109243
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number25793
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: