Provider Demographics
NPI:1205804150
Name:AWAD, EHAB (PA-C)
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:
Last Name:AWAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 306B
Mailing Address - Street 2:WOODROW BRANCH RD
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-9731
Mailing Address - Country:US
Mailing Address - Phone:304-799-7366
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 52W
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:WV
Practice Address - Zip Code:24924-9643
Practice Address - Country:US
Practice Address - Phone:304-799-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV845363AM0700X
WV5975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAWPA17964Medicare ID - Type UnspecifiedMEDICARE