MEDICARE: DR. ROBERT A MUSSON 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	207Q00000X	Family Medicine Physician	35-06-0566M	OH
2	174400000X	Specialist	MD048666L	PA
3	208D00000X	General Practice Physician	049834	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	145755H10	OTHER	PA	GROUP MEMBER PTAN

General Provider Information

NPI Number	:	1669471462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT A MUSSON MD

Provider Business Mailing Address
First Line	:	397 CHURCHILL HUBBARD RD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1375
Country	:	US
Telephone Number	:	330-759-6750
Fax Number	:	330-759-6750

Provider Business Practice Location Address
First Line	:	3618 W MARKET ST
Second Line	:	SUITE 102
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2425
Country	:	US
Telephone Number	:	330-668-2744
Fax Number	:	330-668-2934

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	05/05/2015

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