Provider Demographics
NPI:1780445403
Name:MUSUMECI, MARIANO JOSEPH III (PA-C)
Entity type:Individual
Prefix:
First Name:MARIANO
Middle Name:JOSEPH
Last Name:MUSUMECI
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:MUSUMECI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3 E STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-3810
Mailing Address - Country:US
Mailing Address - Phone:302-437-6304
Mailing Address - Fax:
Practice Address - Street 1:3 E STONEWALL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-3810
Practice Address - Country:US
Practice Address - Phone:302-437-6304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty