1164455101 NPI number — DR. ZAINAB SHAMMA MD

Table of content: DR. ZAINAB SHAMMA MD (NPI 1164455101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164455101 NPI number — DR. ZAINAB SHAMMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAMMA
Provider First Name:
ZAINAB
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1164455101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 DAWKINS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24901-9302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-793-3530
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 DAWKINS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24901-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-647-1148
Provider Business Practice Location Address Fax Number:
304-793-2208
Provider Enumeration Date:
07/09/2006

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: 207RP1001X , with the licence number:  15358 , 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: 0071049000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021 . This is a "MTST BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 282383 . This is a "ANTHEM BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4502260 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 58176 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 110083097 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 249373 . This is a "MAMSI" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 124146001 . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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