Provider Demographics
NPI:1093748360
Name:MOUCHATI, RIZKALLA A (MD)
Entity Type:Individual
Prefix:DR
First Name:RIZKALLA
Middle Name:A
Last Name:MOUCHATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS ST
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0908
Mailing Address - Country:US
Mailing Address - Phone:617-786-0066
Mailing Address - Fax:617-786-7471
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:SUITE 1H
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-786-0066
Practice Address - Fax:617-786-7471
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA483772084N0402X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3012336Medicaid
MA3012336Medicaid