Provider Demographics
NPI:1336263607
Name:MOHAMAD ARJA
Entity Type:Organization
Organization Name:MOHAMAD ARJA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ARJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-367-0012
Mailing Address - Street 1:110 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2818
Mailing Address - Country:US
Mailing Address - Phone:304-367-0012
Mailing Address - Fax:304-366-1092
Practice Address - Street 1:110 GASTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2818
Practice Address - Country:US
Practice Address - Phone:304-367-0012
Practice Address - Fax:304-366-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV042205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9306501Medicare ID - Type Unspecified