Basic Information
Provider Information
NPI: 1013127638
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALMUBARAK
FirstName: MOHAMMED
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 897
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 265070897
CountryCode: US
TelephoneNumber: 3042937401
FaxNumber: 3042936963
Practice Location
Address1: 1 MEDICAL CENTER DRIVE
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 26505
CountryCode: US
TelephoneNumber: 3042934229
FaxNumber: 3045984871
Other Information
ProviderEnumerationDate: 05/23/2007
LastUpdateDate: 04/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X21944WVY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


Home