MEDICARE: MID-ATLANTIC RETINA CONSULTATIONS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	14244	WV

General Provider Information

NPI Number	:	1558316968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-ATLANTIC RETINA CONSULTATIONS, INC.

Provider Business Mailing Address
First Line	:	3120 COLLINS FERRY RD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-3305
Country	:	US
Telephone Number	:	304-599-2733
Fax Number	:	304-599-4428

Provider Business Practice Location Address
First Line	:	3120 COLLINS FERRY RD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-3305
Country	:	US
Telephone Number	:	304-599-2733
Fax Number	:	304-599-4428

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NABIL M. JABBOUR
Credential	:	M.D.
Telephone Number	:	304-599-2733

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	04/04/2008

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