Provider Demographics
NPI:1578550679
Name:EL-HARAKE, MAYEZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYEZ
Middle Name:A
Last Name:EL-HARAKE
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 1:275 DRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2605
Mailing Address - Country:US
Mailing Address - Phone:304-253-6060
Mailing Address - Fax:304-929-2248
Practice Address - Street 1:275 DRY HILL RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2605
Practice Address - Country:US
Practice Address - Phone:304-253-6060
Practice Address - Fax:304-929-2248
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17770207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807025000Medicaid
WVHA0767133Medicare ID - Type Unspecified
WV1807025000Medicaid