Provider Demographics
NPI:1467465104
Name:COLETTE MOUSSALLI MD PC
Entity Type:Organization
Organization Name:COLETTE MOUSSALLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-285-4315
Mailing Address - Street 1:8921 THREE CHOPT ROAD
Mailing Address - Street 2:STE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4601
Mailing Address - Country:US
Mailing Address - Phone:804-285-9315
Mailing Address - Fax:804-288-5332
Practice Address - Street 1:8921 THREE CHOPT ROAD
Practice Address - Street 2:STE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4601
Practice Address - Country:US
Practice Address - Phone:804-285-9315
Practice Address - Fax:804-288-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09245Medicare PIN
VA00W113C01Medicare PIN
B60052Medicare UPIN