Provider Demographics
NPI:1649489469
Name:BASSAM HAFFAR INC
Entity type:Organization
Organization Name:BASSAM HAFFAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-395-3332
Mailing Address - Street 1:6 WOODCREST LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2472
Mailing Address - Country:US
Mailing Address - Phone:304-395-3332
Mailing Address - Fax:
Practice Address - Street 1:117 7TH AVE
Practice Address - Street 2:
Practice Address - City:S CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1417
Practice Address - Country:US
Practice Address - Phone:304-395-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
65610OtherUNICARE
304841OtherADVANTRA FREEDOM COVERNTRY
WV3810010229Medicaid
0007894724OtherAETNA
89M935491WV01OtherANTHEM BCBS
001751446OtherMOUNTAIN STATE BCBS
41204900C2OtherOPTIMUM CHOICE
DD3845OtherRAILROAD MEDICARE
89M935491WV01OtherANTHEM BCBS
WV3810010229Medicaid