Provider Demographics
NPI:1285697326
Name:ULLAH, MOHAMMAD ANWAR (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ANWAR
Last Name:ULLAH
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 1:435 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3413
Mailing Address - Country:US
Mailing Address - Phone:304-465-5066
Mailing Address - Fax:304-465-5066
Practice Address - Street 1:435 MAIN ST W
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3413
Practice Address - Country:US
Practice Address - Phone:304-465-5066
Practice Address - Fax:304-465-5066
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV9931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVD91190Medicare UPIN