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General NPI Number Information
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NPI Number | 1740599919
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Entity Type | Organization
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Legal Business Name | AMJAD MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 330 N EISENHOWER DR
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City | BECKLEY
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State | WV
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Zip | 25801
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Country | US
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Telephone | 304-252-5900
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Fax | 604-252-5915
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Provider Business Mailing Address
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Address Line | 330 N EISENHOWER DR
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City | BECKLEY
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State | WV
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Zip | 25801
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Country | US
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Telephone | 304-252-5900
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Fax | 604-252-5915
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Authorized Official
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Title or Position | OWNER
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Name | DR. QUARTEL-AYNE AMJAD
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Credential | MD
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Telephone | 304-252-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 24182
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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