Provider Demographics
NPI:1619181161
Name:RALEIGH CARDIOLOGY CLINIC PLLC
Entity Type:Organization
Organization Name:RALEIGH CARDIOLOGY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JEBRAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-250-0200
Mailing Address - Street 1:1836 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-250-0200
Mailing Address - Fax:
Practice Address - Street 1:1836 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3366
Practice Address - Country:US
Practice Address - Phone:304-250-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9370201Medicare PIN