Basic Information
| Provider Information | |||||||||
| NPI: | 1477874295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AL-JAROUSHI | ||||||||
| FirstName: | HATIM | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 MACCORKLE AVE SE STE 205 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047207305 | ||||||||
| FaxNumber: | 3047207310 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 MACCORKLE AVE SE STE 205 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047207305 | ||||||||
| FaxNumber: | 3047207310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2010 | ||||||||
| LastUpdateDate: | 04/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0000X | 0101254486 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | 207R00000X | 26700 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 26700 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 26700 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | WV6289A | 01 | WV | MEDICARE PTAN | OTHER | 1477874295 | 05 | WV | MEDICAID |