Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 18061 | WV |
NPI | 1528165214 |
---|---|
Provider Name | Inas Hassan Al-Attar |
First Address | Princeton, WV 24740-2354 |
Second Address | Princeton, WV 24740-2354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 05/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001721779 | BLUE CROSS BLUE SHIELD (01) | |
0109538000 | (05) | WV |
4610271 | AETNA (01) | |
G00633 | (02) |