Provider Demographics
NPI:1669576880
Name:MOUSSA, MOHAMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:
Last Name:MOUSSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 6TH AVENUE
Mailing Address - Street 2:PEDIATRIC HEALTHCARE ASSOCIATES
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16002
Mailing Address - Country:US
Mailing Address - Phone:814-944-7383
Mailing Address - Fax:814-944-7608
Practice Address - Street 1:615 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16002
Practice Address - Country:US
Practice Address - Phone:814-944-7383
Practice Address - Fax:814-944-7608
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037762L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP0000893OtherGATEWAY
PA075608OtherMEDT
PA0006809800001Medicaid
PA19834OtherGEISINGER
PA001537OtherBS
PA203339OtherUPMC BEST
PA34161OtherHEALTH ASSUR
B29835Medicare UPIN