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1306178256

NPI Code Detail

MEDICARE: MOTAZ MOUSSA MD

MEDICARE: MOTAZ MOUSSA 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	207RC0000X	Cardiovascular Disease Physician	35.129093	OH
2	207RI0011X	Interventional Cardiology Physician	35.129093	OH
3	207RI0011X	Interventional Cardiology Physician	ME156847	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01784682	OTHER	OH	RAILROAD MEDICARE - MHCPI

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	:	1306178256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOTAZ MOUSSA MD

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-0449
Country	:	US
Telephone Number	:	740-374-4500
Fax Number	:	740-374-5887

Provider Business Practice Location Address
First Line	:	410 LIONEL WAY STE 201
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-7809
Country	:	US
Telephone Number	:	863-422-5331
Fax Number	:	863-422-5336

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

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	10/23/2023

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Directions to “ MOTAZ MOUSSA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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