Basic Information
| Provider Information | |||||||||
| NPI: | 1700998150 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYYAN | ||||||||
| FirstName: | YASER | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1249 15TH STREET | ||||||||
| Address2: | STE 3000 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911000 | ||||||||
| FaxNumber: | 3046911693 | ||||||||
| Practice Location | |||||||||
| Address1: | 1249 15TH STREET | ||||||||
| Address2: | STE 3000 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911000 | ||||||||
| FaxNumber: | 3046911693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 9060 | ND | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207R00000X | 24037 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 24037 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 3810017799 | 05 | WV | MEDICAID | 11973 | 05 | ND | MEDICAID |