Healthcare Provider Details

I. General information

NPI: 1578675492
Provider Name (Legal Business Name): SAMUEL A MUSCARI SR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HOWARD AVENUE FAMILY HEALTHCARE ASSOC INC
MULLENS WV
25882
US

IV. Provider business mailing address

PO BOX 1650 MAIN STREET FAMILY HEALTH CARE ASSOCIATES INC
PINEVILLE WV
24874-1650
US

V. Phone/Fax

Practice location:
  • Phone: 304-294-4880
  • Fax: 304-294-6480
Mailing address:
  • Phone: 304-732-6735
  • Fax: 304-732-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number466
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: