Provider Demographics
NPI:1033140066
Name:KOJA, ABED (MD)
Entity Type:Individual
Prefix:
First Name:ABED
Middle Name:
Last Name:KOJA
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 1:504 CHERRY ST
Mailing Address - Street 2:BUILDING D
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3306
Mailing Address - Country:US
Mailing Address - Phone:304-325-2600
Mailing Address - Fax:304-324-2135
Practice Address - Street 1:504 CHERRY ST
Practice Address - Street 2:BUILDING D
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3306
Practice Address - Country:US
Practice Address - Phone:304-325-2600
Practice Address - Fax:304-324-2135
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087956207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2673923Medicaid
OHP00348114OtherRAILROAD MEDICARE
OHB58681Medicare UPIN
OH4196951Medicare PIN