Provider Demographics
NPI:1376805705
Name:MUSSA, KASSIM ALI
Entity Type:Individual
Prefix:MR
First Name:KASSIM
Middle Name:ALI
Last Name:MUSSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 OLD COLUMBIA PIKE APT 1112
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2555
Mailing Address - Country:US
Mailing Address - Phone:240-688-2545
Mailing Address - Fax:
Practice Address - Street 1:11700 OLD COLUMBIA PIKE APT 1112
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2555
Practice Address - Country:US
Practice Address - Phone:240-688-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide