Provider Demographics
NPI:1225031701
Name:AL-ASBAHI, RIAD (MD)
Entity Type:Individual
Prefix:
First Name:RIAD
Middle Name:
Last Name:AL-ASBAHI
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 1:1021 QUARRIER ST
Mailing Address - Street 2:STE 301
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2313
Mailing Address - Country:US
Mailing Address - Phone:304-343-4625
Mailing Address - Fax:304-343-4626
Practice Address - Street 1:1021 QUARRIER ST
Practice Address - Street 2:STE 301
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2313
Practice Address - Country:US
Practice Address - Phone:304-343-4625
Practice Address - Fax:304-343-4626
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV121002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0123695000Medicaid
WV001718122OtherBLUE CROSS
WV4094071Medicare ID - Type Unspecified
WV0123695000Medicaid
WV300134813Medicare ID - Type UnspecifiedRAILROAD MEDICARE