Healthcare Provider Details

I. General information

NPI: 1154942407
Provider Name (Legal Business Name): INAS H AL-ATTAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 UNDERCLIFF TER
PRINCETON WV
24740-2175
US

IV. Provider business mailing address

143 UNDERCLIFF TER
PRINCETON WV
24740-2175
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-0415
  • Fax: 304-487-0417
Mailing address:
  • Phone: 304-487-0415
  • Fax: 304-487-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. INAS H AL-ATTAR
Title or Position: EXECUTIVE
Credential: MD
Phone: 304-487-0415