Provider Demographics
NPI:1457476525
Name:M I DABABNAH MD INC
Entity Type:Organization
Organization Name:M I DABABNAH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:DABABNAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-255-4845
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:856 S. RITTER DR
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-0247
Mailing Address - Country:US
Mailing Address - Phone:304-255-4845
Mailing Address - Fax:304-255-4845
Practice Address - Street 1:856 S. RITTER DR.
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-255-4845
Practice Address - Fax:304-255-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10670261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134848OtherUMWA
WV8750169013OtherME
WI3810009229Medicaid
WV8750169013OtherME
WVD49534Medicare UPIN