Provider Demographics
NPI:1538128863
Name:SAFI, IHSAN OMER (MD)
Entity Type:Individual
Prefix:DR
First Name:IHSAN
Middle Name:OMER
Last Name:SAFI
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 1:5 WESTWOOD MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605
Mailing Address - Country:US
Mailing Address - Phone:276-322-3925
Mailing Address - Fax:276-322-3951
Practice Address - Street 1:5 WESTWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-322-3925
Practice Address - Fax:276-322-3951
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049197174400000X, 207R00000X
WV17223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSA4038681Medicaid
VA041530OtherANTHEM BCBS OF VA
WV0075603000Medicaid
VA541672919OtherTAX ID
VA460000434Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA541672919OtherTAX ID
WV0075603000Medicaid
VAE30902Medicare UPIN
WVSA4038681Medicaid