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General NPI Number Information
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NPI Number | 1457476525
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Entity Type | Organization
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Legal Business Name | M I DABABNAH MD INC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 856 S. RITTER DR.
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City | BEAVER
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State | WV
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Zip | 25813
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Country | US
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Telephone | 304-255-4845
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Fax | 304-255-4845
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Provider Business Mailing Address
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Address Line | PO BOX 247 856 S. RITTER DR
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City | BEAVER
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State | WV
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Zip | 25813-0247
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Country | US
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Telephone | 304-255-4845
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Fax | 304-255-4845
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MOUSA I DABABNAH
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Credential | M.D
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Telephone | 304-255-4845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 10670
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License Number State | WV
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