Provider Demographics
NPI:1770682395
Name:KANAWHA NEPHROLOGY, INC.
Entity Type:Organization
Organization Name:KANAWHA NEPHROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-344-2900
Mailing Address - Street 1:2345 CHESTERFIELD AVE # INC
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1062
Mailing Address - Country:US
Mailing Address - Phone:304-344-2900
Mailing Address - Fax:304-344-9385
Practice Address - Street 1:2345 CHESTERFIELD AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1062
Practice Address - Country:US
Practice Address - Phone:304-344-2900
Practice Address - Fax:304-344-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0240023000Medicaid
WVKA9324521Medicare ID - Type Unspecified