Provider Demographics
NPI:1700845559
Name:GHARIB, ELIE G (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:G
Last Name:GHARIB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4610 KANAWHA AVE, SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1364
Mailing Address - Country:US
Mailing Address - Phone:304-205-7992
Mailing Address - Fax:304-205-7739
Practice Address - Street 1:4610 KANAWHA AVE SW
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1367
Practice Address - Country:US
Practice Address - Phone:304-205-7992
Practice Address - Fax:304-205-7739
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2013-01-18
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Provider Licenses
StateLicense IDTaxonomies
WV19778207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2247483Medicaid
WV3002421000Medicaid
KY64033616Medicaid
WVH38094Medicare UPIN
WV4051943Medicare PIN