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: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 PINEVIEW DR STE 100
MORGANTOWN WV
26505-2712
US

IV. Provider business mailing address

1188 PINEVIEW DR STE 100
MORGANTOWN WV
26505-2712
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-7934
  • Fax: 304-599-7936
Mailing address:
  • Phone: 681-285-8755
  • Fax: 304-825-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: