Provider Demographics
NPI:1245221035
Name:SAFFOURI, FREDERICK K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:K
Last Name:SAFFOURI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6444
Mailing Address - Country:US
Mailing Address - Phone:304-255-2121
Mailing Address - Fax:304-256-5419
Practice Address - Street 1:200 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6444
Practice Address - Country:US
Practice Address - Phone:304-255-2121
Practice Address - Fax:304-256-5419
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV839363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00147302OtherRR MCARE
WVPA16143Medicare ID - Type Unspecified
WVP00147302OtherRR MCARE