Provider Demographics
NPI:1245592161
Name:MOUSTAFA, HALA SADEK (MBBCH/MD)
Entity type:Individual
Prefix:
First Name:HALA
Middle Name:SADEK
Last Name:MOUSTAFA
Suffix:
Gender:F
Credentials:MBBCH/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2018
Mailing Address - Country:US
Mailing Address - Phone:774-469-4999
Mailing Address - Fax:508-796-2361
Practice Address - Street 1:266 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2018
Practice Address - Country:US
Practice Address - Phone:774-469-4999
Practice Address - Fax:508-796-2361
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA2681992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program