1669576880 NPI number — DR. MOHAMAD MOUSSA MD

Table of content: DR. MOHAMAD MOUSSA MD (NPI 1669576880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669576880 NPI number — DR. MOHAMAD MOUSSA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOUSSA
Provider First Name:
MOHAMAD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669576880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 6TH AVENUE
Provider Second Line Business Mailing Address:
PEDIATRIC HEALTHCARE ASSOCIATES
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-944-7383
Provider Business Mailing Address Fax Number:
814-944-7608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 6TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-944-7383
Provider Business Practice Location Address Fax Number:
814-944-7608
Provider Enumeration Date:
09/08/2006

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: 208000000X , with the licence number:  MD037762L , 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)

  • Identifier: P0000893 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 075608 . This is a "MEDT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006809800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19834 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001537 . This is a "BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 203339 . This is a "UPMC BEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 34161 . This is a "HEALTH ASSUR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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