Provider Demographics
NPI:1376505222
Name:MOUSSA-GABOUR, GLORIA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:MOUSSA-GABOUR
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 1:20 E EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3521
Mailing Address - Country:US
Mailing Address - Phone:781-979-4040
Mailing Address - Fax:781-979-0808
Practice Address - Street 1:20 E EMERSON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3521
Practice Address - Country:US
Practice Address - Phone:781-979-4040
Practice Address - Fax:781-979-0808
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080050682OtherRAIL ROAD MEDICARE
MA3104206Medicaid
MA076850OtherTUFTS HEALTH PLAN
MA70396OtherHPHC
MAJ13338Medicare PIN