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General NPI Number Information
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NPI Number | 1790448454
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Entity Type | Organization
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Legal Business Name | MS-HC PA PLLC
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 901 W ASHLAND AVE
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City | GLENOLDEN
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State | PA
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Zip | 19036-1101
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Country | US
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Telephone | 610-461-6522
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Fax |
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Provider Business Mailing Address
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Address Line | 9601 PULASKI PARK DR STE 417
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-1409
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | CONSTANTINE MISOUL
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Credential |
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Telephone | 410-933-5618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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