Provider Demographics
NPI:1194735456
Name:HANNA-MOUSSA, ABDULLAH (MD)
Entity type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:
Last Name:HANNA-MOUSSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7972 W THUNDERBIRD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4903
Mailing Address - Country:US
Mailing Address - Phone:623-249-7551
Mailing Address - Fax:
Practice Address - Street 1:7972 W THUNDERBIRD RD STE 104
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4903
Practice Address - Country:US
Practice Address - Phone:623-249-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41644207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ451541Medicaid
AZ451541Medicaid
H44287Medicare UPIN