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General NPI Number Information
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NPI Number | 1407980543
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Entity Type | Organization
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Legal Business Name | FOUR SEASONS NUCLEAR MEDICINE, PLLC
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 15A WESTWOOD MEDICAL PARK
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City | BLUEFIELD
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State | VA
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Zip | 24605-2000
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Country | US
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Telephone | 276-326-1132
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Fax | 276-326-1137
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Provider Business Mailing Address
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Address Line | PO BOX 1537
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City | BLUEFIELD
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State | WV
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Zip | 24701-1537
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Country | US
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Telephone | 276-326-1132
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Fax | 276-326-1133
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NAEEM A QAZI
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Credential | M.D.
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Telephone | 276-326-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101040972
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License Number State | VA
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