Provider Demographics
NPI:1467455915
Name:KUREISHY, ZAVEEN AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:ZAVEEN
Middle Name:AHMAD
Last Name:KUREISHY
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 1:426 8TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1451
Mailing Address - Country:US
Mailing Address - Phone:304-845-8444
Mailing Address - Fax:304-845-8446
Practice Address - Street 1:426 8TH ST
Practice Address - Street 2:STE 102
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-845-8444
Practice Address - Fax:304-845-8446
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2024-02-07
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
OH73810207Q00000X, 207R00000X
WV19309207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2060013Medicaid
WV0081471000Medicaid
WV19309OtherSTATE LICENSE
OH73810OtherOHIO LICENSE
Y29268Medicare UPIN
WV9351461Medicare PIN
OH2060013Medicaid