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General NPI Number Information
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NPI Number | 1053344200
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Entity Type | Individual
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Provider Name | ASSAAD M. MOUNZER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 488 CHERRY ST BLDG E
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City | BLUEFIELD
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State | WV
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Zip | 24701-3304
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Country | US
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Telephone | 304-323-3018
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Fax | 304-323-3021
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Provider Business Mailing Address
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Address Line | 488 CHERRY ST BLDG E
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City | BLUEFIELD
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State | WV
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Zip | 24701-3304
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Country | US
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Telephone | 304-323-3018
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Fax | 304-323-3021
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101043068
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License Number State | VA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 218683
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | ANTHEM BLUE CROSS
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Identifier #2
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Identifier Code | 010322588
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Identifier Type | MEDICAID
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Identifier State | VA
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Identifier Issuer |
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Identifier #3
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Identifier Code | 0129976000
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Identifier Type | MEDICAID
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Identifier State | WV
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 010322588
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Identifier Type | MEDICAID
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Identifier State | VA
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Identifier Issuer |
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Identifier #2
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Identifier Code | 0129976000
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Identifier Type | MEDICAID
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Identifier State | WV
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Identifier Issuer |
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Identifier #3
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Identifier Code | 218683
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | ANTHEM BLUE CROSS
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