Healthcare Provider Details

I. General information

NPI: 1366531287
Provider Name (Legal Business Name): AHMED HUSARI, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 PINEVIEW DR
MORGANTOWN WV
26505
US

IV. Provider business mailing address

400 C DEPOT ST P O BOX 303
BURNSVILLE WV
26335-0303
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-1100
  • Fax: 304-599-1353
Mailing address:
  • Phone: 304-853-2461
  • Fax: 304-853-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberWV17283
License Number StateWV

VIII. Authorized Official

Name: PROF. AHMED W HUSARI
Title or Position: PRESIDENT / MEDICAL DIRECTOR
Credential: MD
Phone: 304-853-2461