Basic Information
| Provider Information | |||||||||
| NPI: | 1386630424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOUSSA | ||||||||
| FirstName: | SAMI | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 W CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107765100 | ||||||||
| FaxNumber: | 6106633113 | ||||||||
| Practice Location | |||||||||
| Address1: | 2416 3RD ST | ||||||||
| Address2: | |||||||||
| City: | WHITEHALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180524822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102642188 | ||||||||
| FaxNumber: | 6102643391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD062259L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 20051993 | 01 | AMERIHEALTH MERCY | OTHER | 50063084 | 01 | CBC | OTHER | P006221 | 01 | GATEWAY HEALTH PLAN | OTHER | 0016494100005 | 05 | PA | MEDICAID | 0478234000 | 01 | IBC | OTHER | 110230305 | 01 | RR MEDICARE | OTHER | 129943 | 01 | UNISON | OTHER | 537537 | 01 | HIGHMARK BLUE SHIELD | OTHER |