Provider Demographics
NPI:1437241346
Name:SADAT, TAOUFIK A (MD)
Entity Type:Individual
Prefix:DR
First Name:TAOUFIK
Middle Name:A
Last Name:SADAT
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 1:22 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3615
Mailing Address - Country:US
Mailing Address - Phone:304-252-4216
Mailing Address - Fax:304-253-6809
Practice Address - Street 1:22 MALLARD CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3615
Practice Address - Country:US
Practice Address - Phone:304-252-4216
Practice Address - Fax:304-253-6809
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20564207W00000X
VA0101231292207W00000X
SC019996207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6308953Medicaid
WV550784974-0001OtherCIGNA HEALTH CARE
WV001722843OtherBCBS
WV180044216OtherRAILROAD RETIRMENT FUND
WV550784974OtherACORDIA NATIONAL
WV001722842OtherBCBS
WV550784974OtherTRICARE
WV7088367OtherAETNA
WV39622OtherCARELINK
WV91562OtherUNICARE
WV1841345000Medicaid
WV502010OtherNATIONAL VISION ADMIN
WV55-0784974OtherMEDICAL DEVELOPMENT INT
WV39622OtherCARELINK
WVH37146Medicare UPIN
WVTASP03521Medicare ID - Type Unspecified
WV1841345000Medicaid