Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | WV26250 | WV |
Y | 2084N0600X | Clinical Neurophysiologist | WV26250 | WV |
N | 2084V0102X | Vascular Neurology | WV26250 | WV |
NPI | 1508097395 |
---|---|
Provider Name | Dr. Zaid Abed Al-Kariem A. Al-Qudah |
First Address | Bridgeport, WV 26330-9009 |
Second Address | Bridgeport, WV 26330-9009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 13/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810029639 | (05) | WV |
WV5419A | (02) | WV |
WV5419A | MEDICARE ID (01) | WV |