{
"Npi": {
"NPI": "1952401697",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MUSANA",
"FirstName": "KENNETH",
"MiddleName": "APOLLO",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "742 SOUTH GOVERNORS AVE",
"SecondLineMailingAddress": "STE 3",
"MailingAddressCityName": "DOVER",
"MailingAddressStateName": "DE",
"MailingAddressPostalCode": "19904-4111",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-678-5008",
"MailingAddressFaxNumber": "302-678-5505",
"FirstLinePracticeLocationAddress": "121 NATIONWIDE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LYNCHBURG",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24502-4272",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-384-1862",
"PracticeLocationAddressFaxNumber": "434-384-7704",
"EnumerationDate": "09/23/2006",
"LastUpdateDate": "02/20/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "44975",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "0101243775",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207RG0100X",
"TaxonomyName": "Gastroenterology Physician",
"LicenseNumber": "0101243775",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207RG0100X",
"TaxonomyName": "Gastroenterology Physician",
"LicenseNumber": "C10025179",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}