Provider Demographics
NPI:1376629592
Name:SYED, SAFIULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:SAFIULLAH
Middle Name:
Last Name:SYED
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:PO BOX 1128
Mailing Address - Street 2:1014 JOHNSTOWN ROAD
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-1128
Mailing Address - Country:US
Mailing Address - Phone:304-252-4433
Mailing Address - Fax:304-252-1703
Practice Address - Street 1:1014 JOHNSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4940
Practice Address - Country:US
Practice Address - Phone:304-252-4433
Practice Address - Fax:304-252-1703
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV195882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001709973OtherBCBS
WV0280016000Medicaid
WVAP9290091OtherRR MEDICARE
WVSY0886521Medicare PIN
WVAP9290091OtherRR MEDICARE