Provider Demographics
NPI:1386630424
Name:MOUSSA, SAMI H (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMI
Middle Name:H
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 1:421 W CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5100
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:2416 3RD ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-4822
Practice Address - Country:US
Practice Address - Phone:610-264-2188
Practice Address - Fax:610-264-3391
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062259L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20051993OtherAMERIHEALTH MERCY
50063084OtherCBC
P006221OtherGATEWAY HEALTH PLAN
PA0016494100005Medicaid
0478234000OtherIBC
110230305OtherRR MEDICARE
129943OtherUNISON
537537OtherHIGHMARK BLUE SHIELD
537537OtherHIGHMARK BLUE SHIELD
P006221OtherGATEWAY HEALTH PLAN