Provider Demographics
NPI:1811178106
Name:NAZER, HUSAM M (MD)
Entity type:Individual
Prefix:MR
First Name:HUSAM
Middle Name:M
Last Name:NAZER
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:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-1189
Mailing Address - Country:US
Mailing Address - Phone:304-253-0849
Mailing Address - Fax:304-253-1573
Practice Address - Street 1:429 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2805
Practice Address - Country:US
Practice Address - Phone:304-253-0849
Practice Address - Fax:304-253-1573
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000570612OtherBC/BS WV
WV0071942000Medicaid
WV000570612OtherBC/BS WV
WV100014852Medicare PIN
WV0621524Medicare PIN