Provider Demographics
NPI:1477654531
Name:MOHAREB, MONA MILAD (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:MILAD
Last Name:MOHAREB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:MILAD
Other - Last Name:WAHBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3 E BENJAMIN DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2705
Mailing Address - Country:US
Mailing Address - Phone:304-455-8000
Mailing Address - Fax:
Practice Address - Street 1:3 E BENJAMIN DR
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2705
Practice Address - Country:US
Practice Address - Phone:304-455-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21381207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I32135Medicare UPIN