Provider Demographics
NPI:1225047749
Name:MOUFARREGE, GHASSAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:T
Last Name:MOUFARREGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6822 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-8453
Mailing Address - Country:US
Mailing Address - Phone:304-412-1076
Mailing Address - Fax:
Practice Address - Street 1:1623 13TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3845
Practice Address - Country:US
Practice Address - Phone:304-526-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053861A207L00000X
WV27850207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology