Provider Demographics
NPI:1598906802
Name:DAOUADI, MUSTAPHA (MD)
Entity Type:Individual
Prefix:
First Name:MUSTAPHA
Middle Name:
Last Name:DAOUADI
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 1:3000 MON HEALTH MEDICAL PARK DR STE 3300
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1169
Mailing Address - Country:US
Mailing Address - Phone:304-599-1448
Mailing Address - Fax:304-599-5335
Practice Address - Street 1:3000 MON HEALTH MEDICAL PARK DR STE 3300
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1169
Practice Address - Country:US
Practice Address - Phone:304-599-1448
Practice Address - Fax:304-599-5335
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461041208600000X
MI4301503608208600000X, 208600000X
WV31763208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery