MEDICARE: MUSA MARK MOMOH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D52900	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184607277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUSA MARK MOMOH MD

Provider Business Mailing Address
First Line	:	12150 ANNAPOLIS RD
Second Line	:	SUITE 205
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9183
Country	:	US
Telephone Number	:	301-805-1103
Fax Number	:	301-805-1104

Provider Business Practice Location Address
First Line	:	12150 ANNAPOLIS RD
Second Line	:	SUITE 205
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9183
Country	:	US
Telephone Number	:	301-805-1103
Fax Number	:	301-805-1104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	09/15/2014

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