Provider Demographics
NPI:1932653375
Name:SHAHZAD, MOAZZAM (MD)
Entity Type:Individual
Prefix:
First Name:MOAZZAM
Middle Name:
Last Name:SHAHZAD
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 1:122 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1047
Mailing Address - Country:US
Mailing Address - Phone:443-983-8346
Mailing Address - Fax:
Practice Address - Street 1:2900 1ST AVE RM 1025
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-399-7484
Practice Address - Fax:304-399-7579
Is Sole Proprietor?:No
Enumeration Date:2016-08-13
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28906207R00000X
FLME154349208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine