Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 35087956 | OH |
NPI | 1033140066 |
---|---|
Provider Name | Abed Koja |
First Address | Bluefield, WV 24701-3306 |
Second Address | Bluefield, WV 24701-3306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 21/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2673923 | (05) | OH |
B58681 | (02) | OH |
P00348114 | RAILROAD MEDICARE (01) | OH |