Healthcare Provider Details

I. General information

NPI: 1720411697
Provider Name (Legal Business Name): RAKAN SALEH A ALBALAWY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 15TH ST STE 2000
HUNTINGTON WV
25701-3662
US

IV. Provider business mailing address

1448 10TH AVE STE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1000
  • Fax:
Mailing address:
  • Phone: 304-691-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number31125
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: