Individual
MR. MOUSA I DABABNAH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
856 RITTER DR, BEAVER, WV 25813-9513
(304) 255-4845
(304) 255-4845
Mailing address
856 RITTER DR, P.O. BOX 247, BEAVER, WV 25813-9513
(304) 255-4845
(304) 255-4845
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
10670
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054813000
—
WV
01
—
0134848
UMWA
WV
01
—
358504041001
BCBS
WV
01
—
8750169013
ME
WV
01
—
AS106200
PEIA
WV
Enumeration date
06/09/2006
Last updated
07/08/2007
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