Provider Demographics
NPI:1689849630
Name:DIN, KALEEM-UD (MD)
Entity Type:Individual
Prefix:
First Name:KALEEM-UD
Middle Name:
Last Name:DIN
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:PO BOX 457
Mailing Address - Street 2:5 E ALVON ROAD, SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5051
Practice Address - Street 1:1 ARH LANE
Practice Address - Street 2:
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-6011
Practice Address - Fax:540-862-6472
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012419Medicaid
VA9411155OtherAETNA
WV100452602OtherDEPT OF LABOR
WV1073729OtherWV COMPENSATION
WV2058507OtherMOUNTAIN ST BCBS
WV2058507OtherMOUNTAIN ST BCBS
VAPO0657148Medicare PIN