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General NPI Number Information
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NPI Number | 1619961232
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Entity Type | Individual
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Provider Name | BASSAM MOUSHMOUSH MD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 331 LAIDLEY ST SUITE 331
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City | CHARLESTON
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State | WV
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Zip | 25301-1619
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Country | US
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Telephone | 304-347-2042
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Fax | 304-347-2091
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Provider Business Mailing Address
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Address Line | 1211 HOSPITAL DR
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City | HURRICANE
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State | WV
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Zip | 25526-8707
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Country | US
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Telephone | 304-757-4694
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Fax | 304-757-4695
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 16432
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License Number State | WV
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