Provider Demographics
NPI:1679731467
Name:SRAJ, SHAFIC ABDULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAFIC
Middle Name:ABDULLAH
Last Name:SRAJ
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 1:177 MIDDLETOWN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8254
Mailing Address - Country:US
Mailing Address - Phone:304-598-4830
Mailing Address - Fax:
Practice Address - Street 1:29 HOSPITAL PLZ
Practice Address - Street 2:STE C
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8470
Practice Address - Country:US
Practice Address - Phone:304-406-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24178207XS0106X, 207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine