Provider Demographics
NPI:1871541383
Name:MOUSSALLI, COLETTE (MD)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:MOUSSALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 THREE CHOPT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4601
Mailing Address - Country:US
Mailing Address - Phone:804-285-9315
Mailing Address - Fax:804-288-5332
Practice Address - Street 1:8921 THREE CHOPT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4601
Practice Address - Country:US
Practice Address - Phone:804-285-9315
Practice Address - Fax:804-288-5332
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033420207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
B60052Medicare UPIN
VACO9245Medicare PIN
VA00W113C01Medicare PIN