Individual
ZAKI M ELSARRAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 E BENJAMIN DR, NEW MARTINSVILLE, WV 26155-2705
(304) 455-8000
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101057267
VA
207P00000X
Emergency Medicine Physician
Primary
17865
WV
207R00000X
Internal Medicine Physician
0101057267
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00601919
BLUE CROSS BLUE SHIELD
WV
05
—
007503000
—
WV
05
—
010275610
—
VA
01
—
1042794
BRICKSTREET
WV
01
—
11101163
CAQH
—
01
—
P00336893
RR MEDICARE BLUEFIELD
—
Enumeration date
05/22/2006
Last updated
04/18/2022
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