Healthcare Provider Details

I. General information

NPI: 1295787414
Provider Name (Legal Business Name): SHIRIN M MORAD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 WASHINGTON ST
RAVENSWOOD WV
26164-1730
US

IV. Provider business mailing address

PO BOX 609
ELIZABETH WV
26143-0609
US

V. Phone/Fax

Practice location:
  • Phone: 304-273-1033
  • Fax: 304-273-1034
Mailing address:
  • Phone: 304-275-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3148
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: