Provider Demographics
NPI:1245056043
Name:MOURAD, AHMED
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:MOURAD
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 1:2600 MIDDLETOWN CMNS
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:WV
Mailing Address - Zip Code:26554-0159
Mailing Address - Country:US
Mailing Address - Phone:540-676-7171
Mailing Address - Fax:
Practice Address - Street 1:2600 MIDDLETOWN CMNS
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:WV
Practice Address - Zip Code:26554-0159
Practice Address - Country:US
Practice Address - Phone:540-676-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)