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General NPI Number Information
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NPI Number | 1821057621
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Entity Type | Individual
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Provider Name | ALI OLIASHIRAZI MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 1600 MEDICAL CENTER DR SUITE G500
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City | HUNTINGTON
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State | WV
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Zip | 25701-3656
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Country | US
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Telephone | 304-691-1262
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 MEDICAL CENTER DR SUITE G500
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City | HUNTINGTON
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State | WV
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Zip | 25701-3656
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Country | US
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Telephone | 304-691-1262
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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 | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 19175
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 19175
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 19175
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License Number State | WV
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