Provider Demographics
NPI:1366531287
Name:AHMED HUSARI, MD, INC
Entity type:Organization
Organization Name:AHMED HUSARI, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MEDICAL DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-853-2461
Mailing Address - Street 1:400 C DEPOT ST
Mailing Address - Street 2:P O BOX 303
Mailing Address - City:BURNSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26335-0303
Mailing Address - Country:US
Mailing Address - Phone:304-853-2461
Mailing Address - Fax:304-853-2468
Practice Address - Street 1:1194 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-1100
Practice Address - Fax:304-599-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV17283174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000748762OtherBC/BS MOUNTAIN STATE
WV356813OtherMAMSI
WV0204374000Medicaid
WV105121OtherBLACK LUNG
WV290015332OtherTRAVELERS RAILROAD MEDICA
WVWV17283GOtherHEALTH PLAN WV
WVAH9319755Medicare ID - Type UnspecifiedMEDICARE ID NUMBER