Healthcare Provider Details

I. General information

NPI: 1598794059
Provider Name (Legal Business Name): M F ANWAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 220 SOUTH BLACKBURN SQUARE
KEYSER WV
26726-2512
US

IV. Provider business mailing address

1500 LAFAYETTE AVE
MOUNDSVILLE WV
26041-2345
US

V. Phone/Fax

Practice location:
  • Phone: 304-788-5118
  • Fax: 304-788-6366
Mailing address:
  • Phone: 304-845-0908
  • Fax: 304-845-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number000603
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD FAROOQ ANWAR
Title or Position: PRESIDENT
Credential: MD
Phone: 304-845-0908