MEDICARE: DR. YUSR ABOUSHAAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	18109	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	77-0592661	OTHER	WV	FEIN, TAX ID

General Provider Information

NPI Number	:	1477503027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YUSR ABOUSHAAR MD

Provider Business Mailing Address
First Line	:	5314 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304
Country	:	US
Telephone Number	:	304-925-4600
Fax Number	:	304-925-4601

Provider Business Practice Location Address
First Line	:	5314 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2222
Country	:	US
Telephone Number	:	304-925-4600
Fax Number	:	304-925-4601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/04/2017

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