Provider Demographics
NPI:1639361595
Name:MOUSSA, HIND N (MD)
Entity Type:Individual
Prefix:
First Name:HIND
Middle Name:N
Last Name:MOUSSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 3750
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1264
Mailing Address - Country:US
Mailing Address - Phone:937-610-3220
Mailing Address - Fax:937-610-3225
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 3750
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-610-3220
Practice Address - Fax:937-610-3225
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4789207V00000X
OH35129280207V00000X, 207VM0101X
IA37669207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0179441Medicaid
OHH490530Medicare PIN