Provider Demographics
NPI:1083666598
Name:PHARES, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:PHARES
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 1:6 N WIND WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1117
Mailing Address - Country:US
Mailing Address - Phone:304-240-5967
Mailing Address - Fax:
Practice Address - Street 1:1027 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4343
Practice Address - Country:US
Practice Address - Phone:301-533-3300
Practice Address - Fax:301-533-3299
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21259207Q00000X
MDD0086835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2005711000Medicaid
WVPH4114892Medicare ID - Type Unspecified
WV2005711000Medicaid