Provider Demographics
NPI:1780675645
Name:MUSA, ABDULGHAFFAR (MD)
Entity Type:Individual
Prefix:
First Name:ABDULGHAFFAR
Middle Name:
Last Name:MUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABED
Other - Middle Name:
Other - Last Name:MUSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:101 S WARREN ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1147
Mailing Address - Country:US
Mailing Address - Phone:315-423-0208
Mailing Address - Fax:315-423-0255
Practice Address - Street 1:101 S WARREN ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1147
Practice Address - Country:US
Practice Address - Phone:315-423-0208
Practice Address - Fax:315-423-0255
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121670207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00536181Medicaid
NYBB1344Medicare PIN
NY00536181Medicaid