MEDICARE: AHMAD BALI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	21044	WV
2	208600000X	Surgery Physician	21044	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689670069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMAD BALI MD

Provider Business Mailing Address
First Line	:	400 S RUFFNER RD STE 2
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25314-1542
Country	:	US
Telephone Number	:	304-346-2254
Fax Number	:	304-346-3184

Provider Business Practice Location Address
First Line	:	400 S RUFFNER RD STE 2
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25314-1542
Country	:	US
Telephone Number	:	304-346-2254
Fax Number	:	304-346-3184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/28/2025

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Directions to “ AHMAD BALI MD” Practice Location

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