Provider Demographics
NPI:1528022795
Name:HARRAH, GREGORY S (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:HARRAH
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 1:226 COBBLESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9362
Mailing Address - Country:US
Mailing Address - Phone:304-757-7092
Mailing Address - Fax:304-757-7093
Practice Address - Street 1:3857 TEAYS VALLEY RD
Practice Address - Street 2:SUITE I
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9480
Practice Address - Country:US
Practice Address - Phone:304-757-7052
Practice Address - Fax:304-757-7093
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0044935000Medicaid
WV0898031Medicare ID - Type Unspecified
WV0044935000Medicaid