Healthcare Provider Details

I. General information

NPI: 1902426455
Provider Name (Legal Business Name): ASEF OBAID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

IV. Provider business mailing address

138 CAMDEN CIR APT 208
SCOTT DEPOT WV
25560-6015
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-3600
  • Fax:
Mailing address:
  • Phone: 321-527-9067
  • Fax:

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 Number33839
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: