=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184680548
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAEEM A QAZI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 09/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 WESTWOOD MEDICAL PARK
-----------------------------------------------------
City | BLUEFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24605-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-326-1136
-----------------------------------------------------
Fax | 276-326-1137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 WESTWOOD MEDICAL PARK
-----------------------------------------------------
City | BLUEFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24605-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-326-1136
-----------------------------------------------------
Fax | 276-326-1137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 12143
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 0101040972
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------