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General NPI Number Information
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NPI Number | 1831115559
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Entity Type | Individual
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Provider Name | MOHAMADO MUSTHAQ M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 520 N COLUMBUS BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4226
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Country | US
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Telephone | 215-923-8042
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Fax | 215-923-8064
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Provider Business Mailing Address
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Address Line | 505 MONTICELLO LN
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1275
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Country | US
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Telephone | 484-213-4712
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Fax | 215-923-8064
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD062265L
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License Number State | PA
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