Provider Demographics
NPI:1023425899
Name:MOUSA, RAFIF (MD)
Entity type:Individual
Prefix:
First Name:RAFIF
Middle Name:
Last Name:MOUSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21500 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3302
Mailing Address - Country:US
Mailing Address - Phone:216-577-8860
Mailing Address - Fax:216-785-2123
Practice Address - Street 1:21500 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126
Practice Address - Country:US
Practice Address - Phone:216-577-8860
Practice Address - Fax:216-785-2123
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116027444390200000X
OH35.133846207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0116027444OtherSTATE OF VIRGINIA MEDICAL LICENSE