Organization
GHAZALA QUDDUS, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON LEWIS (OFFICE MANAGER)
(304) 752-3883
Entity
Organization
Contact information
Practice address
167 STOLLINGS AVE, LOGAN, WV 25601-4010
(304) 752-8800
(304) 752-9000
Mailing address
167 STOLLINGS AVE, LOGAN, WV 25601-4010
(304) 752-8800
(304) 752-9000
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4000440000
—
WV
05
—
65920670
—
KY
Enumeration date
07/10/2006
Last updated
05/08/2008
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