Provider Demographics
NPI:1619961133
Name:FAROUN, YACOUB J (MD)
Entity Type:Individual
Prefix:
First Name:YACOUB
Middle Name:J
Last Name:FAROUN
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 1:1600 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5671
Mailing Address - Country:US
Mailing Address - Phone:484-503-4600
Mailing Address - Fax:484-503-4679
Practice Address - Street 1:1600 ST LUKES BLVD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5671
Practice Address - Country:US
Practice Address - Phone:484-503-4600
Practice Address - Fax:484-503-4679
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21909207RH0003X
PAMD417049207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002655Medicaid
WVH46060OtherCARELINK
WVP00233473OtherRAILROAD MEDICARE
WVH46060OtherWELLS FARGO / PEIA
WVH46060OtherAETNA
WVWV21909OtherHEALTH PLAN
WV001757872OtherMOUNTAIN STATE BCBS
WVH46060OtherUNITED HEALTH CARE
WVP00233473OtherRAILROAD MEDICARE
4159611Medicare ID - Type Unspecified