Provider Demographics
NPI:1437182540
Name:MUSTAFA, MASROOR (MD)
Entity Type:Individual
Prefix:
First Name:MASROOR
Middle Name:
Last Name:MUSTAFA
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 1:91 5TH ST SE
Mailing Address - Street 2:SUMMIT PULMONOLOGY & INTERNAL MEDICINE, INC.
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4203
Mailing Address - Country:US
Mailing Address - Phone:330-753-1499
Mailing Address - Fax:
Practice Address - Street 1:91 FIFTH STREET SE
Practice Address - Street 2:SUMMIT PULMONARY INTERNAL MEDICINE INC
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203
Practice Address - Country:US
Practice Address - Phone:330-753-1383
Practice Address - Fax:330-753-1499
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-1622-M207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2026239Medicaid
OH2026239Medicaid
OHMU7301851Medicare PIN