Provider Demographics
NPI:1528565926
Name:REZKO, RAGHEB (MD)
Entity Type:Individual
Prefix:
First Name:RAGHEB
Middle Name:
Last Name:REZKO
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:PO BOX 9203
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9203
Mailing Address - Country:US
Mailing Address - Phone:304-293-1621
Mailing Address - Fax:304-293-2925
Practice Address - Street 1:1 MEDICAL CENTER DR RM 2305
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:304-293-1621
Practice Address - Fax:304-293-2925
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program