| Fairmont Neurology Clinic, Pllc | |
|
1188 Pineview Dr Ste 100 Morgantown WV 26505-2712 | |
| (681) 285-8755 | |
| (304) 825-6577 |
| Full Name | Fairmont Neurology Clinic, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1188 Pineview Dr Ste 100, Morgantown, West Virginia |
| Authorized Official Name and Position | Mouhannad Azzouz (OWNER) |
| Authorized Official Contact | 3045987000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairmont Neurology Clinic, Pllc Po Box 333 Pursglove WV 26546-0333 Ph: (681) 285-8755 | Fairmont Neurology Clinic, Pllc 1188 Pineview Dr Ste 100 Morgantown WV 26505-2712 Ph: (681) 285-8755 |
| NPI Number | 1609974641 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 05/31/2024 |
| Certification Date | 05/31/2024 |
| Medicare PECOS PAC ID | 3779597315 |
|---|---|
| Medicare Enrollment ID | O20060202000540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609974641 | NPI | - | NPPES |
| WV20408 | Other | WV | THE HEALTH PLAN |
| 7787352 | Other | WV | AETNA |
| 001721746 | Other | WV | BLUE CROSS BLUE SHIELD |
| 1807858000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | WV20408 (West Virginia) | Primary |
| Provider Name | Mouhannad Azzouz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760506018 PECOS PAC ID: 8022022664 Enrollment ID: I20060207000515 |
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