Provider Demographics
NPI:1265487771
Name:KURDI, MOSTAFA (MD,FCCP)
Entity Type:Individual
Prefix:DR
First Name:MOSTAFA
Middle Name:
Last Name:KURDI
Suffix:
Gender:M
Credentials:MD,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HOSPITAL PLAZA
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8471
Mailing Address - Country:US
Mailing Address - Phone:304-269-0030
Mailing Address - Fax:304-269-0034
Practice Address - Street 1:29 HOSPITAL PLAZA
Practice Address - Street 2:SUITE B
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8471
Practice Address - Country:US
Practice Address - Phone:304-269-0030
Practice Address - Fax:304-269-0034
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24582207RC0200X, 207RP1001X, 207RS0012X
SC32469207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810021812Medicaid
WV3810021812Medicaid
NC5905035Medicaid
SCGP4505Medicaid
NC2056386Medicare ID - Type Unspecified
NC5904930OtherCAROLINA ACCESS
SCN0119CMedicaid
NCP00345067OtherRAILROAD MEDICARE
NCH80826Medicare UPIN