Provider Demographics
NPI:1053344200
Name:MOUNZER, ASSAAD M (MD)
Entity type:Individual
Prefix:DR
First Name:ASSAAD
Middle Name:M
Last Name:MOUNZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ASSAAD
Other - Middle Name:
Other - Last Name:MOUNZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:488 CHERRY ST
Mailing Address - Street 2:BLDG E
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3304
Mailing Address - Country:US
Mailing Address - Phone:304-323-3018
Mailing Address - Fax:304-323-3021
Practice Address - Street 1:488 CHERRY ST
Practice Address - Street 2:BLDG E
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3304
Practice Address - Country:US
Practice Address - Phone:304-323-3018
Practice Address - Fax:304-323-3021
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043068208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA218683OtherANTHEM BLUE CROSS
VA010322588Medicaid
WV0129976000Medicaid
VA011094T57Medicare PIN
VA010322588Medicaid
WV0129976000Medicaid