Provider Demographics
NPI:1457536492
Name:DR. RAGHDA SAHLOUL, INC.
Entity Type:Organization
Organization Name:DR. RAGHDA SAHLOUL, INC.
Other - Org Name:DR. RAGHDA SAHLOUL MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-345-8665
Mailing Address - Street 1:3100 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-345-8665
Mailing Address - Fax:304-345-8662
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 606
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-345-8665
Practice Address - Fax:304-345-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20791174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1841086000Medicaid
WV9327401Medicare PIN
WV1841086000Medicaid
WVH69762Medicare UPIN
WV4090351Medicare Oscar/Certification