Provider Demographics
NPI:1124147384
Name:MUHIB S. TARAKJI M.D.
Entity type:Organization
Organization Name:MUHIB S. TARAKJI M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHIB
Authorized Official - Middle Name:S
Authorized Official - Last Name:TARAKJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-766-2101
Mailing Address - Street 1:418 GREENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1426
Mailing Address - Country:US
Mailing Address - Phone:304-766-2101
Mailing Address - Fax:304-766-2225
Practice Address - Street 1:418 GREENWAY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1426
Practice Address - Country:US
Practice Address - Phone:304-766-2101
Practice Address - Fax:304-766-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096577001Medicaid