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General NPI Number Information
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NPI Number | 1649490731
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Entity Type | Organization
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Legal Business Name | LOGAN HEMATOLOGY-ONCOLOGY INC
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 77 HOSPITAL DRIVE
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City | LOGAN
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State | WV
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Zip | 25601-3451
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Country | US
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Telephone | 304-792-1116
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Fax | 304-792-1133
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Provider Business Mailing Address
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Address Line | PO BOX 58176
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City | CHARLESTON
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State | WV
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Zip | 25358-0176
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Country | US
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Telephone | 304-792-1116
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Fax | 304-792-1133
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SAFIQUE AHMED
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Credential | M.D.
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Telephone | 304-792-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 20171
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License Number State | WV
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