Provider Demographics
NPI:1811914476
Name:MUSARRA, ANTHONY M (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:MUSARRA
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 1:216 LILY RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8421
Mailing Address - Country:US
Mailing Address - Phone:609-635-2838
Mailing Address - Fax:
Practice Address - Street 1:216 LILY RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8421
Practice Address - Country:US
Practice Address - Phone:609-635-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83954207RA0401X
PAMA051464L207R00000X
NJMA60953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMU864754Medicare PIN
NJF77809Medicare UPIN