1629061973 NPI number — DR. LO'AY M. AL-ASADI MD

Table of content: DR. LO'AY M. AL-ASADI MD (NPI 1629061973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629061973 NPI number — DR. LO'AY M. AL-ASADI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-ASADI
Provider First Name:
LO'AY
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629061973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2335 CHESTERFIELD AVE STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25304-1066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-346-0311
Provider Business Mailing Address Fax Number:
304-346-5533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 CHESTERFIELD AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25304-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-925-7676
Provider Business Practice Location Address Fax Number:
304-925-7679
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  16919 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 16919 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 550767806004 . This is a "BLUE CROSS BLUE SHIELD NO" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0075240000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290012816 . This is a "RAILROAD MEDICARE NO" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 290103 . This is a "MAMSI GROUP NO." identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4000227000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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