Provider Demographics
NPI:1144415290
Name:ABU-HALIMAH, SHADI J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHADI
Middle Name:J
Last Name:ABU-HALIMAH
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:415 MORRIS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1842
Mailing Address - Country:US
Mailing Address - Phone:304-388-6412
Mailing Address - Fax:304-388-6416
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1842
Practice Address - Country:US
Practice Address - Phone:304-388-6412
Practice Address - Fax:304-388-6416
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2021-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY494762086S0129X
WV237452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810021280Medicaid
WVWV0576AMedicare PIN