Provider Demographics
NPI:1356478663
Name:SHAMMAA, AMMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMMAR
Middle Name:
Last Name:SHAMMAA
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 1:4803 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1309
Mailing Address - Country:US
Mailing Address - Phone:304-766-9600
Mailing Address - Fax:304-766-9606
Practice Address - Street 1:4803 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1309
Practice Address - Country:US
Practice Address - Phone:304-766-9600
Practice Address - Fax:304-766-9606
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22915207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010610Medicaid
WV3810010610Medicaid