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NPI Code Detail

MEDICARE: DR. WISSAM H. MUSTAFA M.D.

MEDICARE: DR. WISSAM H. MUSTAFA M.D.
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
1207L00000XAnesthesiology Physician268570MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598028250
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WISSAM H. MUSTAFA M.D.
Provider Business Mailing Address
First Line : 960 MASSACHUSETTS AVENUE
Second Line : FL 2
City : BOSTON
State : MA
Zip : 02118-2690
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 BOSTON MEDICAL CTR PL
Second Line :
City : BOSTON
State : MA
Zip : 02118-2908
Country : US
Telephone Number : 617-638-6950
Fax Number : 617-638-6966
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2012
Last Update Date : 01/26/2026

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