Healthcare Provider Details

I. General information

NPI: 1790231025
Provider Name (Legal Business Name): RIDWAAN ALBEIRUTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506
US

IV. Provider business mailing address

PO BOX 9160
MORGANTOWN WV
26506-9160
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-4239
  • Fax:
Mailing address:
  • Phone: 304-293-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301503738
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number28246
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: