Provider Demographics
NPI:1285052696
Name:TARHSONG ASHUKEM, MOSES (MD)
Entity type:Individual
Prefix:
First Name:MOSES
Middle Name:
Last Name:TARHSONG ASHUKEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOSES
Other - Middle Name:T
Other - Last Name:ASHUKEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:956-603-1333
Mailing Address - Fax:956-380-4433
Practice Address - Street 1:4302 S SUGAR RD STE 200
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9140
Practice Address - Country:US
Practice Address - Phone:956-603-1333
Practice Address - Fax:956-380-4433
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54102207R00000X
TXT0706207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1Q1025OtherPTAN