Provider Demographics
NPI:1952367666
Name:PERVAIZ, NAEEM (MD)
Entity Type:Individual
Prefix:
First Name:NAEEM
Middle Name:
Last Name:PERVAIZ
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 1:608 NEW HOPE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2273
Mailing Address - Country:US
Mailing Address - Phone:304-425-1522
Mailing Address - Fax:304-487-9447
Practice Address - Street 1:608 NEW HOPE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2273
Practice Address - Country:US
Practice Address - Phone:304-425-1522
Practice Address - Fax:304-487-9447
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11606208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001720055OtherBCBS
WV0130715000Medicaid
WVPE0449581Medicare PIN
406343640Medicare ID - Type UnspecifiedRR MEDICARE
WV0130715000Medicaid