Provider Demographics
NPI:1861468415
Name:HARB, WAEL A (MD)
Entity Type:Individual
Prefix:
First Name:WAEL
Middle Name:A
Last Name:HARB
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 1:1441 AVOCADO AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7704
Mailing Address - Country:US
Mailing Address - Phone:949-272-2095
Mailing Address - Fax:949-272-2096
Practice Address - Street 1:1441 AVOCADO AVE STE 301
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7704
Practice Address - Country:US
Practice Address - Phone:949-272-2095
Practice Address - Fax:949-272-2096
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044990A207R00000X, 207RH0003X, 207RX0202X
MI4301116641207RH0003X, 207RX0202X
CAC172708207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000658155OtherANTHEM PROVIDER NUMBER
IN200173610Medicaid
MI1861468415Medicaid
ING67014Medicare UPIN
INP00843959Medicare PIN
IN815150008Medicare PIN
IN898190F3Medicare PIN
IN200173610Medicaid