Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 23745 | WV |
N | 2086S0129X | Vascular Surgeon | 49476 | KY |
NPI | 1144415290 |
---|---|
Provider Name | Dr. Shadi J Abu-Halimah |
First Address | Charleston, WV 25301-1842 |
Second Address | Charleston, WV 25301-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810021280 | (05) | WV |