MEDICARE: MR. KASSIM ALI MUSSA

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	374U00000X	Home Health Aide		MD

General Provider Information

NPI Number	:	1376805705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KASSIM ALI MUSSA

Provider Business Mailing Address
First Line	:	11700 OLD COLUMBIA PIKE APT 1112
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-2555
Country	:	US
Telephone Number	:	240-688-2545
Fax Number	:

Provider Business Practice Location Address
First Line	:	11700 OLD COLUMBIA PIKE APT 1112
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-2555
Country	:	US
Telephone Number	:	240-688-2545
Fax Number	:

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

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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