Fairmont Neurology Clinic, PLLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

WV20408 Issued in WV

Legal business name

FAIRMONT NEUROLOGY CLINIC, PLLC

Practice address

1188 Pineview Dr Ste 100
Morgantown, WV 26505-2712

Phone

(681) 285-8755

Fax

(304) 825-6577

NPI assigned

Sep 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mouhannad Azzouz, MDNPI 1760506018

Title

Owner

Phone

(304) 598-7000

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mouhannad Azzouz, M.D.

  • Neurology Physician
  • Morgantown, WV
  • NPI 1760506018
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1609974641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 333",
            "city": "PURSGLOVE",
            "state": "WV",
            "postal_code": "265460333",
            "telephone_number": "681-285-8755",
            "fax_number": "304-825-6577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1188 PINEVIEW DR STE 100",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265052712",
            "telephone_number": "681-285-8755",
            "fax_number": "304-825-6577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRMONT NEUROLOGY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "AZZOUZ",
        "authorized_official_first_name": "MOUHANNAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-598-7000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WV",
            "license": "WV20408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE HEALTH PLAN",
            "identifier": "WV20408",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7787352",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001721746",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1807858000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra M Everly, PHYSICAL THERAPIST
• Vicki L Everly, M.D.
• Brittany Fabiano
• Macey Faidley
• Fairmont Home Equipment & Supply Company
• Thomas Fakadej
• Jacob Falis
• John Francis Xavier Fallon, D.D.S., M.S.
• Alexa Falo
• Robin Falor, LPC

• Neurology Physician in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Neurology Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.