Provider Demographics
NPI:1235170192
Name:DABABNAH, MOUSA I (MD)
Entity Type:Individual
Prefix:MR
First Name:MOUSA
Middle Name:I
Last Name:DABABNAH
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 1:856 RITTER DR
Mailing Address - Street 2:P.O. BOX 247
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9513
Mailing Address - Country:US
Mailing Address - Phone:304-255-4845
Mailing Address - Fax:304-255-4845
Practice Address - Street 1:856 RITTER DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-9513
Practice Address - Country:US
Practice Address - Phone:304-255-4845
Practice Address - Fax:304-255-4845
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10670174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8750169013OtherME
WV0134848OtherUMWA
WV0054813000Medicaid
WV358504041001OtherBCBS
WVAS106200OtherPEIA
WV358504041001OtherBCBS