Provider Demographics
NPI:1356300172
Name:MOUSA, SOHA (MD)
Entity Type:Individual
Prefix:
First Name:SOHA
Middle Name:
Last Name:MOUSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 SENNET PL
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1791
Mailing Address - Country:US
Mailing Address - Phone:513-779-0777
Mailing Address - Fax:513-779-5612
Practice Address - Street 1:7116 SENNET PL
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-1791
Practice Address - Country:US
Practice Address - Phone:513-779-0777
Practice Address - Fax:513-779-0777
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084484207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2499461Medicaid
OHP00856796OtherMEDICARE RR
OHP00856796OtherMEDICARE RR
OHI16085Medicare UPIN