Provider Demographics
NPI:1841392479
Name:MUSELLO, KATE M (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:M
Last Name:MUSELLO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 LEAD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3644
Mailing Address - Country:US
Mailing Address - Phone:505-242-6899
Mailing Address - Fax:
Practice Address - Street 1:881 LEAD AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3644
Practice Address - Country:US
Practice Address - Phone:505-242-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4142OtherBLUE CROSS BLUE SHIELD
NM28191OtherNM MEDICAID
NM28191OtherNM MEDICAID