Provider Demographics
NPI:1275575391
Name:MARZOUK, KAMEL ATTEF (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMEL
Middle Name:ATTEF
Last Name:MARZOUK
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 1:20 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3452
Mailing Address - Country:US
Mailing Address - Phone:304-831-1891
Mailing Address - Fax:304-831-1892
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3452
Practice Address - Country:US
Practice Address - Phone:304-831-1891
Practice Address - Fax:304-831-1892
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22266207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005126Medicaid
WVMA7343401Medicare ID - Type Unspecified