Provider Demographics
NPI:1194153825
Name:ALWAAL, AMJAD H (MD)
Entity type:Individual
Prefix:
First Name:AMJAD
Middle Name:H
Last Name:ALWAAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 15TH ST STE 4093
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 20TH ST STE 107
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-0003
Practice Address - Country:US
Practice Address - Phone:304-691-1900
Practice Address - Fax:304-691-1929
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099931208800000X
NJ25MA11001500208800000X
WV28042208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology