Provider Demographics
NPI:1518687037
Name:MUSOBYA, WILSON
Entity Type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:MUSOBYA
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 1:24 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4358
Mailing Address - Country:US
Mailing Address - Phone:781-358-8633
Mailing Address - Fax:781-205-1602
Practice Address - Street 1:24 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4358
Practice Address - Country:US
Practice Address - Phone:781-358-8633
Practice Address - Fax:781-205-1602
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information