Provider Demographics
NPI:1285699405
Name:DAGHER, GHASSAN Y (MD)
Entity type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:Y
Last Name:DAGHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-0180
Mailing Address - Country:US
Mailing Address - Phone:304-442-8076
Mailing Address - Fax:304-442-1348
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2116
Practice Address - Country:US
Practice Address - Phone:304-442-8076
Practice Address - Fax:304-442-1348
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12037207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096645000Medicaid
WV0663820001Medicare NSC
WVD49549Medicare UPIN
WV8803762Medicare PIN