Provider Demographics
NPI:1457692535
Name:RANA, MARYAM JAFARY (PA)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:JAFARY
Last Name:RANA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:MARYAM
Other - Middle Name:JAFAR
Other - Last Name:RANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:56 OSPREY RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3684
Mailing Address - Country:US
Mailing Address - Phone:304-222-5817
Mailing Address - Fax:
Practice Address - Street 1:425 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3145
Practice Address - Country:US
Practice Address - Phone:304-222-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01717202C00000X, 207P00000X, 207R00000X, 2084P0800X
WV0171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry