Provider Demographics
NPI:1447242557
Name:KATRIB, ABDUL KARIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:KARIM
Last Name:KATRIB
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 1:400 DIVISION ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1459
Mailing Address - Country:US
Mailing Address - Phone:304-766-3473
Mailing Address - Fax:304-766-3664
Practice Address - Street 1:400 DIVISION ST
Practice Address - Street 2:SUITE 12
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1459
Practice Address - Country:US
Practice Address - Phone:304-766-3473
Practice Address - Fax:304-766-3664
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV14043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0101519000Medicaid
WV0101519000Medicaid
WV0557146Medicare ID - Type UnspecifiedSO. CHARLESTON OFFICE
WV0557147Medicare ID - Type UnspecifiedLOGAN OFFICE