Provider Demographics
NPI:1669480505
Name:AL-ASHHAB, HAZEM ABDEL-HAFEEZ (MD)
Entity Type:Individual
Prefix:
First Name:HAZEM
Middle Name:ABDEL-HAFEEZ
Last Name:AL-ASHHAB
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 1:2335 CHESTERFIELD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1066
Mailing Address - Country:US
Mailing Address - Phone:304-400-4911
Mailing Address - Fax:304-400-4913
Practice Address - Street 1:705 GARFIELD AVE STE 360
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5444
Practice Address - Country:US
Practice Address - Phone:304-424-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-03523207RG0100X
WV20498207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807982000Medicaid
F94406Medicare UPIN
0779057Medicare ID - Type Unspecified
WV1807982000Medicaid