Provider Demographics
NPI:1821141763
Name:ABDEEN, M ANWAR YAHYA (MD)
Entity Type:Individual
Prefix:DR
First Name:M ANWAR
Middle Name:YAHYA
Last Name:ABDEEN
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 1:106 SOUTHERN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:S CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8689
Mailing Address - Country:US
Mailing Address - Phone:304-744-1192
Mailing Address - Fax:
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2116
Practice Address - Country:US
Practice Address - Phone:304-442-5151
Practice Address - Fax:800-305-3233
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20596207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G34651Medicare UPIN