Provider Demographics
NPI:1740398239
Name:JAFARY, HASSAN ASGHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:ASGHAR
Last Name:JAFARY
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 299
Mailing Address - Street 2:STANAFORD MEDICAL CLINIC
Mailing Address - City:STANAFORD
Mailing Address - State:WV
Mailing Address - Zip Code:25927-0299
Mailing Address - Country:US
Mailing Address - Phone:304-256-8227
Mailing Address - Fax:304-256-8214
Practice Address - Street 1:451 STANAFORD RD
Practice Address - Street 2:STANAFORD MEDICAL CLINIC
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-256-8227
Practice Address - Fax:304-256-8227
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0078438000Medicaid
WV001342551OtherBCBS
WV0078438001Medicaid
0795778Medicare ID - Type Unspecified
WV001342551OtherBCBS