Individual
DR. YUSR ABOUSHAAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5314 MACCORKLE AVE SE, CHARLESTON, WV 25304-2222
(304) 925-4600
(304) 925-4601
Mailing address
5314 MACCORKLE AVE SE, CHARLESTON, WV 25304
(304) 925-4600
(304) 925-4601
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18109
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0109798002
—
WV
01
—
77-0592661
FEIN, TAX ID
WV
Enumeration date
05/12/2006
Last updated
10/04/2017
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