Individual
DR. MOHAMAD SAMAH KALOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5240 MACCORKLE AVE SE, CHARLESTON, WV 25304-2122
(304) 926-2300
(304) 926-2304
Mailing address
500 POPLAR ST, SUITE 204, SOUTH CHARLESTON, WV 25309-1474
(304) 767-7840
(304) 767-7849
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
22493
WV
207Q00000X
Family Medicine Physician
35.088590
OH
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
22493
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001902627
BCBS
WV
05
—
3810006491
—
WV
Enumeration date
10/10/2006
Last updated
08/26/2020
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