Provider Demographics
NPI:1164471546
Name:TARAKJI, HOSSAM SALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:HOSSAM
Middle Name:SALEH
Last Name:TARAKJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HOSSAM
Other - Middle Name:
Other - Last Name:TARAKJI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1400 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9202
Mailing Address - Country:US
Mailing Address - Phone:304-757-1700
Mailing Address - Fax:
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9202
Practice Address - Country:US
Practice Address - Phone:304-757-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089254207P00000X, 207R00000X
WV20648207P00000X
MS16781207R00000X
ALMD.21573207R00000X
IL036-069197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG58775Medicare UPIN