Individual
EMAD Y MOUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
77 HOSPITAL DR STE 200, LOGAN, WV 25601-3451
(304) 896-5200
(304) 896-5300
Mailing address
PO BOX 119, LOGAN, WV 25601
(304) 896-5200
(304) 896-5300
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
24508
WV
207V00000X
Obstetrics & Gynecology Physician
35092078
OH
207VX0000X
Obstetrics Physician
Primary
24508
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003070194
WV MEDICARE
WV
05
—
1003070194
—
WV
01
—
11865318
CAQH
OH
05
—
2873029
—
OH
Enumeration date
07/17/2008
Last updated
03/17/2018
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