Individual
DR. TALAL IMAD MOUSALLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
2010-01468
NC
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
2010-01468
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487812749
TRICARE
NC
01
—
1487812749
VIRGINIA MEDICAID
VA
05
—
1487812749
—
NC
01
—
1846B
BCBS
NC
01
—
276230
MEDCOST
NC
01
—
3846320
UHC
NC
01
—
4762627
AETNA
NC
01
—
Q0146O
SC MEDICAID
SC
Enumeration date
05/22/2008
Last updated
12/18/2014
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