MEDICARE: DR. JOSPHAT S. MUSAPATIKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	36233	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2189376	OTHER	NC	MEDICARE CORE

General Provider Information

NPI Number	:	1285621375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSPHAT S. MUSAPATIKE MD

Provider Business Mailing Address
First Line	:	728 FOREST MILLS RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-2117
Country	:	US
Telephone Number	:	757-373-0725
Fax Number	:

Provider Business Practice Location Address
First Line	:	566 RUIN CREEK RD
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-2927
Country	:	US
Telephone Number	:	252-436-1162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	02/18/2008

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