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General NPI Number Information
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NPI Number | 1578620696
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Entity Type | Individual
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Provider Name | BADSHAH J. WAZIR M.D., F.A.C.C.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 428 DIVISION ST
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309-1469
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Country | US
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Telephone | 304-766-7400
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Fax | 304-766-7446
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Provider Business Mailing Address
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Address Line | 118 E RIDGE RD
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City | CHARLESTON
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State | WV
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Zip | 25314-1666
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11277
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License Number State | WV
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