Healthcare Provider Details

I. General information

NPI: 1881733384
Provider Name (Legal Business Name): JAFAR TAKI ALMASHAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JARAR MASHAT

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 S WATER ST
MARTINSBURG WV
25401-4241
US

IV. Provider business mailing address

40 MARSTON DR
MARTINSBURG WV
25401-8794
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-8954
  • Fax: 304-264-0763
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number18958
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: