Provider Demographics
NPI:1154464626
Name:MOUSSA, FUAD (MD)
Entity Type:Individual
Prefix:
First Name:FUAD
Middle Name:
Last Name:MOUSSA
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 1:12 KELLNER COURT
Mailing Address - Street 2:
Mailing Address - City:TORONTA
Mailing Address - State:ON
Mailing Address - Zip Code:M4L3W4
Mailing Address - Country:CA
Mailing Address - Phone:416-480-4742
Mailing Address - Fax:
Practice Address - Street 1:SUNNYBROOK HOSPITAL
Practice Address - Street 2:2075 BAYVEIW AVE ROOM H406
Practice Address - City:TORONTO
Practice Address - State:ON
Practice Address - Zip Code:M4N3M5
Practice Address - Country:CA
Practice Address - Phone:416-480-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219831208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery