Individual
DR. MICHAEL M MOUSSOUTTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4755 OGLETOWN STANTON RD STE 2E99, NEWARK, DE 19718-2559
(302) 733-5982
Mailing address
4755 OGLETOWN STANTON RD STE 2E99, NEWARK, DE 19718-2200
(856) 630-2406
Taxonomy
Speciality
Code
Description
License number
State
2084A2900X
Neurocritical Care Physician
NCC00372-08
NJ
2084A2900X
Neurocritical Care Physician
NCC00372-08
PA
2084N0400X
Neurology Physician
201294
NY
2084N0400X
Neurology Physician
25MA07658800
NJ
2084N0400X
Neurology Physician
Primary
C1-0012292
DE
2084N0400X
Neurology Physician
MD432784
PA
2084V0102X
Vascular Neurology Physician
25MA07658800
NJ
2084V0102X
Vascular Neurology Physician
MD432784
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018727880005
—
PA
05
—
2095572
—
NJ
Enumeration date
07/28/2005
Last updated
07/21/2022
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