Provider Demographics
NPI:1992918262
Name:MUSA, ROGER (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:MUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2600 6TH ST SW
Mailing Address - Street 2:MEDICAL EDUCATION
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1702
Mailing Address - Country:US
Mailing Address - Phone:330-363-4899
Mailing Address - Fax:330-580-5513
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:MEDICAL EDUCATION
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-4899
Practice Address - Fax:330-580-5513
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35091849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine