Healthcare Provider Details

I. General information

NPI: 1952401697
Provider Name (Legal Business Name): KENNETH APOLLO MUSANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

IV. Provider business mailing address

742 SOUTH GOVERNORS AVE STE 3
DOVER DE
19904-4111
US

V. Phone/Fax

Practice location:
  • Phone: 434-384-1862
  • Fax: 434-384-7704
Mailing address:
  • Phone: 302-678-5008
  • Fax: 302-678-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44975
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101243775
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101243775
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC10025179
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: