Provider Demographics
NPI:1740230994
Name:INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES
Other - Org Name:AUGUSTA LUNG SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:HANI
Authorized Official - Last Name:KANJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-598-2801
Mailing Address - Street 1:99 J D ANDERSON DR
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-598-2801
Mailing Address - Fax:304-599-6463
Practice Address - Street 1:99 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-4000
Practice Address - Country:US
Practice Address - Phone:304-598-2801
Practice Address - Fax:304-599-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19742207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0075141000Medicaid
WV0074630000Medicaid
WVF23641Medicare UPIN
WV0075141000Medicaid
WV9265841Medicare PIN
WV0074630000Medicaid
WV0868663Medicare PIN