Provider Demographics
NPI:1346264900
Name:ABUMOUSSA, LATEEF (MD)
Entity Type:Individual
Prefix:
First Name:LATEEF
Middle Name:
Last Name:ABUMOUSSA
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 1:510 PARK HILL CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4265
Mailing Address - Country:US
Mailing Address - Phone:828-697-1177
Mailing Address - Fax:
Practice Address - Street 1:510 PARK HILL CT
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4265
Practice Address - Country:US
Practice Address - Phone:828-697-1177
Practice Address - Fax:828-697-1176
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8910131Medicare ID - Type Unspecified
NCF87571Medicare UPIN
NC2201605CMedicare ID - Type Unspecified