Healthcare Provider Details

I. General information

NPI: 1477110468
Provider Name (Legal Business Name): MUHAMMAD ABSAR ANWAR MBBS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 10/13/2022
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-1000
  • Fax: 855-206-2136
Mailing address:
  • Phone: 570-888-5858
  • Fax: 570-888-5858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31282
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: