Provider Demographics
NPI:1922144120
Name:KEBLAWI, HISHAM AHMED (MD)
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:AHMED
Last Name:KEBLAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1400
Mailing Address - Fax:304-691-1453
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 4500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3656
Practice Address - Country:US
Practice Address - Phone:304-691-1400
Practice Address - Fax:304-691-1453
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV22561207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0092729000Medicaid
4207951Medicare PIN