Provider Demographics
NPI:1669471462
Name:MUSSON, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MUSSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1375
Mailing Address - Country:US
Mailing Address - Phone:330-759-6750
Mailing Address - Fax:330-759-6750
Practice Address - Street 1:3618 W MARKET ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2425
Practice Address - Country:US
Practice Address - Phone:330-668-2744
Practice Address - Fax:330-668-2934
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-0566M207Q00000X
PAMD048666L174400000X
CT049834208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA145755H10OtherGROUP MEMBER PTAN
OH0872316Medicare PIN
PA145755H10OtherGROUP MEMBER PTAN
OHF13556Medicare UPIN
OH0708315Medicare PIN
OH0708313Medicare PIN
OH0708319Medicare PIN
OH0872317Medicare PIN
OH0872315Medicare PIN