Provider Demographics
NPI:1609849231
Name:RA MUSELLA MD FACS PA
Entity Type:Organization
Organization Name:RA MUSELLA MD FACS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-638-1853
Mailing Address - Street 1:6600 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781
Mailing Address - Country:US
Mailing Address - Phone:231-638-1853
Mailing Address - Fax:239-790-5050
Practice Address - Street 1:6600 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:231-638-1853
Practice Address - Fax:239-790-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2013-05-21
Deactivation Date:2012-10-31
Deactivation Code:
Reactivation Date:2013-05-21
Provider Licenses
StateLicense IDTaxonomies
FLME0018297207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047952700Medicaid
FL047952700Medicaid
K7994Medicare ID - Type Unspecified