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General NPI Number Information
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NPI Number | 1881895100
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Entity Type | Organization
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Legal Business Name | APPALACHIAN GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 429 CARRIAGE DR
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City | BECKLEY
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State | WV
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Zip | 25801-2805
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Country | US
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Telephone | 304-253-0849
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Fax | 304-253-1573
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Provider Business Mailing Address
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Address Line | P.O. BOX 1189
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City | BECKLEY
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State | WV
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Zip | 25802
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Country | US
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Telephone | 304-253-0849
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Fax | 304-253-1573
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Authorized Official
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Title or Position | OWNER
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Name | DR. HUSAM MOHAMMAD NAZER
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Credential | M.D.,FACP,FACG
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Telephone | 304-253-0849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 13335
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License Number State | WV
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