Healthcare Provider Details

I. General information

NPI: 1780292698
Provider Name (Legal Business Name): HUSSEIN JAFFAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD P.O. BOX 9200
MORGANTOWN WV
26506
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-3457
  • Fax: 304-293-2602
Mailing address:
  • Phone: 304-293-3457
  • Fax: 304-293-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number1016
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: