Provider Demographics
NPI:1043323199
Name:ALGHADBAN, ADNAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ADNAN
Middle Name:
Last Name:ALGHADBAN
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 1:527 MEDICAL PARK DRIVE, STE. 204
Mailing Address - Street 2:ASSOCIATED SPECIALISTS, INC.
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:304-933-3800
Mailing Address - Fax:304-933-3815
Practice Address - Street 1:527 MEDICAL PARK DRIVE, STE. 204
Practice Address - Street 2:ASSOCIATED SPECIALISTS, INC.
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-933-3800
Practice Address - Fax:304-933-3814
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV213502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2006875000Medicaid
WV4128721Medicare PIN