Provider Demographics
NPI:1508848227
Name:SAKKAL, AHMED M (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:M
Last Name:SAKKAL
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 1:331 LAIDLEY ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1619
Mailing Address - Country:US
Mailing Address - Phone:304-344-0186
Mailing Address - Fax:304-344-0188
Practice Address - Street 1:331 LAIDLEY ST
Practice Address - Street 2:SUITE 406
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1619
Practice Address - Country:US
Practice Address - Phone:304-344-0186
Practice Address - Fax:304-344-0188
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16395207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801046000Medicaid
WVE60878Medicare UPIN
WV1801046000Medicaid