Provider Demographics
NPI:1164429460
Name:DAR, NASREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NASREEN
Middle Name:
Last Name:DAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 KINGBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-4109
Mailing Address - Country:US
Mailing Address - Phone:304-487-3436
Mailing Address - Fax:
Practice Address - Street 1:6 QUAIL VALLEY MEDICAL CTR
Practice Address - Street 2:200 NEW HOPE RD.
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2139
Practice Address - Country:US
Practice Address - Phone:304-425-9471
Practice Address - Fax:304-425-2127
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV124712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7150482Medicaid
WV0116807000Medicaid
WVD76107Medicare UPIN
WVDA0503393Medicare ID - Type Unspecified