MEDICARE: KANAWHA NEPHROLOGY, INC.

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	207RN0300X	Nephrology Physician

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

General Provider Information

NPI Number	:	1770682395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANAWHA NEPHROLOGY, INC.

Provider Business Mailing Address
First Line	:	2345 CHESTERFIELD AVE # INC
Second Line	:	SUITE 301
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1062
Country	:	US
Telephone Number	:	304-344-2900
Fax Number	:	304-344-9385

Provider Business Practice Location Address
First Line	:	2345 CHESTERFIELD AVE
Second Line	:	SUITE 301
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1062
Country	:	US
Telephone Number	:	304-344-2900
Fax Number	:	304-344-9385

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ASIF RAHMAN
Credential	:	MD
Telephone Number	:	304-344-2900

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	03/06/2008

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