Provider Demographics
NPI:1538111075
Name:ATAI, M. BASHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:BASHAR
Last Name:ATAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:BASHAR
Other - Last Name:AL-ATAIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5131
Mailing Address - Fax:740-446-5486
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-446-5486
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20054207R00000X
OH35-07-2743207R00000X
OH35.072743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV110153381OtherRR MEDICARE
OH2023161OtherMOLINA MEDICAID
OH000000181841OtherUNISON MEDICAID
001714097OtherMOUNTAIN STATE BCBS
WV0081055000Medicaid
000000006565OtherANTHEM BCBS
OH310917085112OtherCARESOURCE MEDICAID
G58825Medicare UPIN
OH2023161OtherMOLINA MEDICAID
OH0833653Medicare PIN