Provider Demographics
NPI:1649356866
Name:FAHEEM, AHMED DAVER (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:DAVER
Last Name:FAHEEM
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 1128
Mailing Address - Street 2:1014 JOHNSTOWN ROAD
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-1128
Mailing Address - Country:US
Mailing Address - Phone:304-252-4433
Mailing Address - Fax:304-252-1703
Practice Address - Street 1:1014 JOHNSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4940
Practice Address - Country:US
Practice Address - Phone:304-252-4433
Practice Address - Fax:304-252-1703
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV128852084P0800X, 2084P0802X, 2084P0804X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720506OtherBCBS
WV0116820000Medicaid
WV260003992OtherRR MEDICARE
WVFA0504794Medicare ID - Type Unspecified
WV0116820000Medicaid