Provider Demographics
NPI:1306932694
Name:RAZZOOK, SALAH PHILIP
Entity type:Individual
Prefix:DR
First Name:SALAH
Middle Name:PHILIP
Last Name:RAZZOOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 S BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1701
Mailing Address - Country:US
Mailing Address - Phone:304-822-4035
Mailing Address - Fax:304-822-7363
Practice Address - Street 1:97 S BOLTON ST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1701
Practice Address - Country:US
Practice Address - Phone:304-822-4035
Practice Address - Fax:304-822-7363
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13418208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
235-913OtherONE NET
WV0128427000Medicaid
060001647OtherRR MEDICARE
335-913OtherONE NET-MAMSI
235-913OtherONE NET
WV0128427000Medicaid