Provider Demographics
NPI:1861467110
Name:MUSARA, M. CORNELIOUS (MD, FACS)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:CORNELIOUS
Last Name:MUSARA
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-0696
Mailing Address - Country:US
Mailing Address - Phone:410-768-0074
Mailing Address - Fax:410-768-0075
Practice Address - Street 1:7671 QUARTERFIELD ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060
Practice Address - Country:US
Practice Address - Phone:410-768-0074
Practice Address - Fax:410-768-0075
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059105208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD378221200Medicaid
MD378221200Medicaid