Provider Demographics
NPI:1356449714
Name:KAZMI, SAMINA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMINA
Middle Name:
Last Name:KAZMI
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 1:415 MORRIS ST STE 403
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1854
Mailing Address - Country:US
Mailing Address - Phone:304-344-0166
Mailing Address - Fax:304-344-5105
Practice Address - Street 1:10050 SW INNOVATION WAY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2117
Practice Address - Country:US
Practice Address - Phone:304-344-0166
Practice Address - Fax:304-344-5105
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD610432972084N0600X, 2084V0102X, 2084N0400X
WV208872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2004431000Medicaid
WV2004431000Medicaid