Healthcare Provider Details

I. General information

NPI: 1356478663
Provider Name (Legal Business Name): AMMAR SHAMMAA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 KENTUCKY ST
SOUTH CHARLESTON WV
25309-1309
US

IV. Provider business mailing address

4803 KENTUCKY ST
SOUTH CHARLESTON WV
25309-1309
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-9600
  • Fax: 304-766-9606
Mailing address:
  • Phone: 304-766-9600
  • Fax: 304-766-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22915
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: