Provider Demographics
NPI:1033144860
Name:MUSSOLINE, JOSEPH FRANCIS
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRANCIS
Last Name:MUSSOLINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LANSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18232-1310
Mailing Address - Country:US
Mailing Address - Phone:570-645-3133
Mailing Address - Fax:
Practice Address - Street 1:134 W RIDGE ST
Practice Address - Street 2:
Practice Address - City:LANSFORD
Practice Address - State:PA
Practice Address - Zip Code:18232-1310
Practice Address - Country:US
Practice Address - Phone:570-645-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005238L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017900740001Medicaid
PA0017900740001Medicaid
PAB35400Medicare UPIN