Provider Demographics
NPI:1326575036
Name:AMJAD, BUSHRA (MD)
Entity type:Individual
Prefix:MS
First Name:BUSHRA
Middle Name:
Last Name:AMJAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVE. SE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-4600
Mailing Address - Fax:304-388-4621
Practice Address - Street 1:3200 MACCORKLE AVE. SE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-4600
Practice Address - Fax:304-388-4621
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2018-01-04
Deactivation Date:2017-12-15
Deactivation Code:
Reactivation Date:2018-01-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program