Provider Demographics
NPI:1568631950
Name:RURAL OUTREACH ARTHRITIS CENTER
Entity Type:Organization
Organization Name:RURAL OUTREACH ARTHRITIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:REZAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-262-0085
Mailing Address - Street 1:2010 DOCTOR OATES DR
Mailing Address - Street 2:104
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8896
Mailing Address - Country:US
Mailing Address - Phone:304-262-0085
Mailing Address - Fax:304-262-0205
Practice Address - Street 1:2010 DOCTOR OATES DR
Practice Address - Street 2:104
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8896
Practice Address - Country:US
Practice Address - Phone:304-262-0085
Practice Address - Fax:304-262-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16112207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVE65375Medicare UPIN