1467619890 NPI number — FEDELE ANTHONY MUSSO DMD

Table of content: FEDELE ANTHONY MUSSO DMD (NPI 1467619890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467619890 NPI number — FEDELE ANTHONY MUSSO DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUSSO
Provider First Name:
FEDELE
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467619890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STATION SQUARE 2
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-644-1502
Provider Business Mailing Address Fax Number:
610-296-7915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STATION SQUARE 2
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-644-1502
Provider Business Practice Location Address Fax Number:
610-296-7915
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS 019136-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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