Provider Demographics
NPI:1578675492
Name:MUSCARI, SAMUEL A SR (DO)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:MUSCARI
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:MAIN STREET FAMILY HEALTH CARE ASSOCIATES INC
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-1650
Mailing Address - Country:US
Mailing Address - Phone:304-732-6735
Mailing Address - Fax:304-732-9218
Practice Address - Street 1:205 HOWARD AVENUE
Practice Address - Street 2:FAMILY HEALTHCARE ASSOC INC
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882
Practice Address - Country:US
Practice Address - Phone:304-294-4880
Practice Address - Fax:304-294-6480
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049249-000Medicaid
0894794OtherMAN
0894794OtherMAN
0894795Medicare ID - Type UnspecifiedGIL
0894793Medicare ID - Type UnspecifiedMUL
WV0049249-000Medicaid
E28884Medicare UPIN