Provider Demographics
NPI:1376548438
Name:MOUGHRABI, BASSEL J (MD)
Entity Type:Individual
Prefix:
First Name:BASSEL
Middle Name:J
Last Name:MOUGHRABI
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 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:
Practice Address - Street 1:65 SHENANDOAH AVE
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3201
Practice Address - Country:US
Practice Address - Phone:540-966-6430
Practice Address - Fax:540-966-1348
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA385142OtherANTHEM
WV54183971800OtherWV WORKERS COMPENSATION
WV3002207000Medicaid
VA005858534Medicaid
5208606OtherAETNA
WV541839718074OtherBS MOUNTAIN STATE
WV385143OtherANTHEM
VA385142OtherANTHEM
5208606OtherAETNA
WV54183971800OtherWV WORKERS COMPENSATION
5208606OtherAETNA
WV541839718074OtherBS MOUNTAIN STATE
VA110008183Medicare ID - Type UnspecifiedTRAILBLAZER HEALTH/VAMC
WV385143OtherANTHEM
154058OtherSOUTHERN HEALTH
G70345Medicare UPIN
154058OtherCARELINK
WVMO4070891Medicare ID - Type UnspecifiedWV MEDICARE