Provider Demographics
NPI:1760506018
Name:AZZOUZ, MOUHANNAD (MD)
Entity Type:Individual
Prefix:
First Name:MOUHANNAD
Middle Name:
Last Name:AZZOUZ
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 1:1188 PINEVIEW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2712
Mailing Address - Country:US
Mailing Address - Phone:681-285-8755
Mailing Address - Fax:304-825-6577
Practice Address - Street 1:1188 PINEVIEW DR STE 100
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2712
Practice Address - Country:US
Practice Address - Phone:304-599-7934
Practice Address - Fax:304-599-7936
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV204082084S0012X, 2084V0102X
WVWV204082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807858000Medicaid
WVWV20408OtherTHE HEALTH PLAN
WV7787352OtherAETNA
WV001783384OtherBCBS INDIVIDUAL
WV1807858000Medicaid