Provider Demographics
NPI:1568406726
Name:RANA, IZHAR A (MD)
Entity Type:Individual
Prefix:
First Name:IZHAR
Middle Name:A
Last Name:RANA
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 5049
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-5049
Mailing Address - Country:US
Mailing Address - Phone:304-425-7127
Mailing Address - Fax:304-425-8707
Practice Address - Street 1:100 NEWHOPE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-425-7127
Practice Address - Fax:304-425-8707
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12625208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0354473OtherUMWA
B09355Medicare UPIN
4043321Medicare PIN