Provider Demographics
NPI:1407840572
Name:AZAR, JOHN J (MD, FACP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:AZAR
Suffix:
Gender:M
Credentials:MD, FACP
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 1286
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26555-1286
Mailing Address - Country:US
Mailing Address - Phone:304-366-0111
Mailing Address - Fax:304-366-2099
Practice Address - Street 1:1200 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3494
Practice Address - Country:US
Practice Address - Phone:304-598-6560
Practice Address - Fax:304-285-2667
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17192207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0077818000Medicaid
CH6378OtherRR MEDICARE
WV830005456OtherRAILROAD MEDICARE
WVWV17192OtherHEALTH PLAN
WV0077818000Medicaid
WV2021AMedicare PIN
WV0077818000Medicaid
WV000645787OtherMOUNTAIN STATE BCBS
WV830005456OtherRAILROAD MEDICARE
WV9300761Medicare PIN
WV830005456OtherRAILROAD MEDICARE
WVE16575OtherWELLS FARGO / PEIA
WVE16575OtherUNITED HEALTH CARE