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General NPI Number Information
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NPI Number | 1962690958
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Entity Type | Individual
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Provider Name | GHASSAN RICHARD GHORAYEB MD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 211 S CHESTNUT ST
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City | CLARKSBURG
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State | WV
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Zip | 26301
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Country | US
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Telephone | 304-624-5212
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 780
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City | MORGANTOWN
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State | WV
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Zip | 26507-0780
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Country | US
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Telephone | 304-285-7101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | BP10029076 TRAINING
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 24904
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License Number State | WV
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