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: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY STE 312
WEIRTON WV
26062-5055
US

IV. Provider business mailing address

PO BOX 779
MORGANTOWN WV
26507-0779
US

V. Phone/Fax

Practice location:
  • Phone: 304-914-4250
  • Fax: 304-914-4255
Mailing address:
  • Phone: 304-797-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: