Provider Demographics
NPI:1629377981
Name:TRABULSI, ALMOUTASSIM MUHAMMADALI
Entity Type:Individual
Prefix:
First Name:ALMOUTASSIM
Middle Name:MUHAMMADALI
Last Name:TRABULSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-7911
Mailing Address - Country:US
Mailing Address - Phone:304-293-2801
Mailing Address - Fax:304-293-9115
Practice Address - Street 1:101 STADIUM DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-7911
Practice Address - Country:US
Practice Address - Phone:304-293-2801
Practice Address - Fax:304-293-9115
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program