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General NPI Number Information
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NPI Number | 1225047749
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Entity Type | Individual
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Provider Name | GHASSAN T MOUFARREGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1623 13TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-3845
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Country | US
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Telephone | 304-526-2243
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Fax |
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Provider Business Mailing Address
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Address Line | 6822 COUNTY ROAD 1
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City | SOUTH POINT
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State | OH
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Zip | 45680-8453
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Country | US
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Telephone | 304-412-1076
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01053861A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 27850
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License Number State | WV
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