Provider Demographics
NPI:1679514954
Name:KANAWATI, YASIER (MD)
Entity Type:Individual
Prefix:
First Name:YASIER
Middle Name:
Last Name:KANAWATI
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 1:510 CHERRY ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3338
Mailing Address - Country:US
Mailing Address - Phone:304-325-5711
Mailing Address - Fax:304-327-1789
Practice Address - Street 1:510 CHERRY ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3338
Practice Address - Country:US
Practice Address - Phone:304-325-5711
Practice Address - Fax:304-327-1789
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12690207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3002999000Medicaid
VA6300138Medicaid
VA6300138Medicaid
D49346Medicare UPIN