Organization
MOUNTAINEER FAMILY MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMAD SAMAH KALOU MD (OWNER)
(304) 767-7840
Entity
Organization
Contact information
Practice address
500 POPLAR ST, SUITE 204, CHARLESTON, WV 25309-1474
(304) 767-7840
(304) 767-7849
Mailing address
PO BOX 11908, CHARLESTON, WV 25339-1908
(304) 767-7840
(304) 767-7849
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22493
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810010965
—
WV
Enumeration date
02/05/2007
Last updated
02/04/2008
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