Provider Demographics
NPI:1760619795
Name:MUSUKU, MARY USHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:USHA
Last Name:MUSUKU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-789-5013
Mailing Address - Fax:
Practice Address - Street 1:TEMPLE UNIVERSITY HOSPITAL
Practice Address - Street 2:BOYER PAVILION 2ND FLOOR,3509 NORTH BROAD STREET
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-707-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2018-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD439389207RG0300X
PAMT187744207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine