Individual
DR. IRAJ DERAKHSHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1206 QUARRIER ST, SUITE 101, CHARLESTON, WV 25301-1810
(304) 343-4098
(304) 343-4598
Mailing address
1206 QUARRIER ST STE 101, CHARLESTON, WV 25301-1810
(304) 343-4098
(304) 343-4598
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18591
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000102711
BCBS
WV
05
—
0090508000
—
WV
Enumeration date
03/23/2006
Last updated
05/13/2014
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