Provider Demographics
NPI:1528026408
Name:ROOPANI, GHAZALA QUDDUS (MD)
Entity Type:Individual
Prefix:
First Name:GHAZALA
Middle Name:QUDDUS
Last Name:ROOPANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GHAZALA
Other - Middle Name:
Other - Last Name:QUDDUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:167 STOLLINGS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-4010
Mailing Address - Country:US
Mailing Address - Phone:304-752-8800
Mailing Address - Fax:304-752-9015
Practice Address - Street 1:167 STOLLINGS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-4010
Practice Address - Country:US
Practice Address - Phone:304-752-8800
Practice Address - Fax:304-752-9015
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29243207RN0300X
LA334317207RN0300X
WV16972207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64698947Medicaid
WV0074880003Medicaid
KY007488000Medicaid
WV180438000Medicaid
KY0656501Medicare PIN
WV0074880003Medicaid
KY0656601Medicare PIN
F40258Medicare UPIN
KY0766701Medicare PIN
KY0725923Medicare PIN
KY00280059Medicare PIN
KY0685901Medicare PIN