Individual
MOHAMADO MUSTHAQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 N COLUMBUS BLVD, PHILADELPHIA, PA 19123-4226
(215) 923-8042
(215) 923-8064
Mailing address
505 MONTICELLO LN, PLYMOUTH MEETING, PA 19462-1275
(484) 213-4712
(215) 923-8064
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD062265L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
568611-000
MIS
PA
Enumeration date
07/14/2006
Last updated
04/18/2012
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