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General NPI Number Information
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NPI Number | 1689808925
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Entity Type | Organization
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Legal Business Name | RALEIGH LUNG CLINIC INCORPORATED PC
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 2401 S KANAWHA ST SUITE 100
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City | BECKLEY
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State | WV
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Zip | 25801-6967
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Country | US
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Telephone | 304-255-6300
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Fax | 304-255-6301
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Provider Business Mailing Address
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Address Line | 43 FOX SPARROW RD
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City | BECKLEY
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State | WV
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Zip | 25801-3687
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Country | US
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Telephone | 304-255-6300
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Fax | 304-255-6301
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Authorized Official
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Title or Position | OWNER
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Name | RAMZI N. HADDADIN
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Credential | MD
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Telephone | 304-255-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 20964
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License Number State | WV
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