Provider Demographics
NPI:1336723758
Name:DAJJANI, MOUSA GHASSAN (MD)
Entity Type:Individual
Prefix:
First Name:MOUSA
Middle Name:GHASSAN
Last Name:DAJJANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 MAC CORKLE AVE. SE
Mailing Address - Street 2:ROBERT C.. BYRD CLINICAL TEACHING CENTER, 5TH FLOOR
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-4600
Mailing Address - Fax:304-388-4621
Practice Address - Street 1:3200 MAC CORKLE AVE. SE
Practice Address - Street 2:ROBERT C.. BYRD CLINICAL TEACHING CENTER, 5TH FLOOR
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-4600
Practice Address - Fax:304-388-4621
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program