Provider Demographics
NPI:1386809184
Name:HARFOUSH, OBAEDA (MD)
Entity type:Individual
Prefix:
First Name:OBAEDA
Middle Name:
Last Name:HARFOUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-6222
Mailing Address - Fax:
Practice Address - Street 1:400 MATTHEW ST STE 305
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1600
Practice Address - Country:US
Practice Address - Phone:740-568-5662
Practice Address - Fax:740-568-5672
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45853207RP1001X
OH35.134416207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0317484Medicaid
KY7100255500Medicaid