Provider Demographics
NPI:1598877409
Name:MUSCARI, SAMUEL A JR (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:MUSCARI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:MAIN STREET
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-1650
Mailing Address - Country:US
Mailing Address - Phone:304-732-6735
Mailing Address - Fax:304-732-9218
Practice Address - Street 1:MAIN STREET
Practice Address - Street 2:FAMILY HEALTCARE ASSOCIATES INC
Practice Address - City:PINEVILLE
Practice Address - State:WV
Practice Address - Zip Code:24874-1650
Practice Address - Country:US
Practice Address - Phone:304-732-6611
Practice Address - Fax:304-732-9161
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049764-000Medicaid
0894823Medicare ID - Type Unspecified
0894824Medicare ID - Type Unspecified
WV0049764-000Medicaid
0894825Medicare ID - Type Unspecified
0894821Medicare ID - Type Unspecified
WVF12745Medicare UPIN