Healthcare Provider Details

I. General information

NPI: 1598906802
Provider Name (Legal Business Name): MUSTAPHA DAOUADI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MON HEALTH MEDICAL PARK DR STE 3300
MORGANTOWN WV
26505-1169
US

IV. Provider business mailing address

3000 MON HEALTH MEDICAL PARK DR STE 3300
MORGANTOWN WV
26505-1169
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-1448
  • Fax: 304-599-5335
Mailing address:
  • Phone: 304-599-1448
  • Fax: 304-599-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD461041
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301503608
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31763
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: