Provider Demographics
NPI:1326204223
Name:YASSER W BARSOUM MD PLLC
Entity Type:Organization
Organization Name:YASSER W BARSOUM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARSOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-424-4680
Mailing Address - Street 1:600 18TH ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3231
Mailing Address - Country:US
Mailing Address - Phone:304-424-4680
Mailing Address - Fax:304-424-4679
Practice Address - Street 1:600 18TH ST
Practice Address - Street 2:SUITE 610
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3231
Practice Address - Country:US
Practice Address - Phone:304-424-4680
Practice Address - Fax:304-424-4679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012901Medicaid
WV9377521Medicare PIN