Provider Demographics
NPI:1952433690
Name:MUSTAFA, NOWWAR G (MD)
Entity Type:Individual
Prefix:DR
First Name:NOWWAR
Middle Name:G
Last Name:MUSTAFA
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 1:734 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4115
Mailing Address - Country:US
Mailing Address - Phone:510-248-1670
Mailing Address - Fax:510-509-2229
Practice Address - Street 1:734 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4115
Practice Address - Country:US
Practice Address - Phone:510-248-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC175533207RI0011X
KY43443207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH139220Medicaid
KY7100123980Medicaid
KY43443OtherLICENSE
OHH393000Medicare PIN
KYP400033741Medicare PIN