Healthcare Provider Details

I. General information

NPI: 1760506018
Provider Name (Legal Business Name): MOUHANNAD AZZOUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MON HEALTH MEDICAL PARK DR STE 1103
MORGANTOWN WV
26505-1143
US

IV. Provider business mailing address

1000 MON HEALTH MEDICAL PARK DR STE 1103
MORGANTOWN WV
26505-1143
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2801
  • Fax:
Mailing address:
  • Phone: 304-598-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberWV20408
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number20408
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number20408
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: