Provider Demographics
NPI:1821084583
Name:MUSSOLINE, JOSEPH FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANK
Last Name:MUSSOLINE
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 1:1637 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1003
Mailing Address - Country:US
Mailing Address - Phone:215-465-7100
Mailing Address - Fax:215-463-3550
Practice Address - Street 1:1637 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1003
Practice Address - Country:US
Practice Address - Phone:215-465-7100
Practice Address - Fax:215-463-3550
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038372E174400000X
NJMA04943100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0409419000OtherAMERIHEALTH
NJ55507OtherUS HEALTHCARE
NJ0409419000OtherAMERIHEALTH
NJ527520Medicare ID - Type Unspecified