Provider Demographics
NPI:1255520409
Name:DR ZAVEEN A KUREISHY
Entity type:Organization
Organization Name:DR ZAVEEN A KUREISHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAVEEN
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:KUREISHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-845-8444
Mailing Address - Street 1:426 8TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1451
Mailing Address - Country:US
Mailing Address - Phone:304-845-8444
Mailing Address - Fax:304-845-8446
Practice Address - Street 1:426 8TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-845-8444
Practice Address - Fax:304-845-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19309207R00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0081471000Medicaid
OH2060013Medicaid
WVF87170Medicare UPIN
WV0081471000Medicaid
WV9351461Medicare PIN