Provider Demographics
NPI:1700828266
Name:MENA, ASHRAF K (MD)
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:K
Last Name:MENA
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:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-0590
Mailing Address - Country:US
Mailing Address - Phone:304-425-0581
Mailing Address - Fax:304-425-0304
Practice Address - Street 1:508 NEW HOPE RD STE 201
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2271
Practice Address - Country:US
Practice Address - Phone:304-425-0581
Practice Address - Fax:304-425-0304
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19793207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0153307000Medicaid
VA5826918Medicaid
WVME0875081Medicare ID - Type Unspecified
VA5826918Medicaid