Provider Demographics
NPI:1427165596
Name:ASSOCIATED SPECIALISTS, INC.
Entity type:Organization
Organization Name:ASSOCIATED SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALGHADBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-933-3800
Mailing Address - Street 1:527 MEDICAL PARK DR STE 204
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9009
Mailing Address - Country:US
Mailing Address - Phone:304-933-3800
Mailing Address - Fax:304-933-3815
Practice Address - Street 1:527 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9009
Practice Address - Country:US
Practice Address - Phone:304-933-3800
Practice Address - Fax:304-933-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RI0200X, 208600000X
WV51D0968213291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0622681Medicaid
WV3810005430Medicaid
WV9293261Medicare PIN