Provider Demographics
NPI:1184622243
Name:MOUSA, MAHER (MD)
Entity type:Individual
Prefix:DR
First Name:MAHER
Middle Name:
Last Name:MOUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:026-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:2545 E THOMAS RD STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-419-3378
Practice Address - Fax:602-595-1528
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32130207RN0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ870312Medicaid
AZI12137Medicare UPIN
AZ870312Medicaid
AZ122260Medicare PIN