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Individual

DR. SAM ABDUL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-4170
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
20404
WV
207P00000X
Emergency Medicine Physician
Primary
4301088857
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000538615
ANTHEM
OH
01
001723882
WV BCBS
WV
01
1056712
WV DWC
WV
05
2000361000
WV
01
20404
LICENSE
WV
05
2803069
OH
01
P00456101
MEDICARE RAIL ROAD
OH
Enumeration date
01/03/2006
Last updated
08/16/2023
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