Provider Demographics
NPI:1689731622
Name:YOUSAF, MOHAMMAD BABAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:BABAR
Last Name:YOUSAF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4607 MACCORKLE AVE SW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309
Mailing Address - Country:US
Mailing Address - Phone:304-766-3688
Mailing Address - Fax:304-766-3484
Practice Address - Street 1:4607 MACCORKLE AVE. SW
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309
Practice Address - Country:US
Practice Address - Phone:304-766-3688
Practice Address - Fax:304-766-3484
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15744207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0008983000Medicaid
WVE00493Medicare UPIN
WV9342301Medicare ID - Type Unspecified