Healthcare Provider Details

I. General information

NPI: 1669471462
Provider Name (Legal Business Name): ROBERT A MUSSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 W MARKET ST SUITE 102
FAIRLAWN OH
44333-2425
US

IV. Provider business mailing address

397 CHURCHILL HUBBARD RD
YOUNGSTOWN OH
44505-1375
US

V. Phone/Fax

Practice location:
  • Phone: 330-668-2744
  • Fax: 330-668-2934
Mailing address:
  • Phone: 330-759-6750
  • Fax: 330-759-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-06-0566M
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD048666L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number049834
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: