Provider Demographics
NPI:1578620696
Name:WAZIR, BADSHAH J (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:BADSHAH
Middle Name:J
Last Name:WAZIR
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:428 DIVISION ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1469
Practice Address - Country:US
Practice Address - Phone:304-766-7400
Practice Address - Fax:304-766-7446
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087269000Medicaid
WV0087269000Medicaid
WVWA0515622Medicare ID - Type Unspecified