DR. TALAL IMAD MOUSALLEM (NPI# 1487812749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1487812749 |
Entity Type | Individual |
Full Name | DR. TALAL IMAD MOUSALLEM |
Credential | M.D. |
Practice Address |
Medical Center Blvd Winston Salem NC 27157-0001 |
Practice Telephone | 3367162255 |
Mailing Telephone | 3367162255 |
Enumeration Date | 2008-05-22 |
Last Update Date | 2014-12-18 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207K00000X | Allergy & Immunology | 2010-01468 | NC | Allopathic & Osteopathic Physicians |
Y | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
2010-01468 | NC | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NC | BCBS | 1846B | 01 |
NC | MEDCOST | 276230 | 01 |
NC | UHC | 3846320 | 01 |
VA | VIRGINIA MEDICAID | 1487812749 | 01 |
NC | AETNA | 4762627 | 01 |
SC | SC MEDICAID | Q0146O | 01 |
NC | 1487812749 | 05 | |
NC | TRICARE | 1487812749 | 01 |
Street Address |
MEDICAL CENTER BLVD |
City | WINSTON SALEM |
State | NC |
Zip Code | 27157-0001 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811990815 | Gary Lee Ray | Registered Nurse | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2005-05-23 |
1881295418 | Alan Townes Grizzard | Nurse Practitioner | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-11-02 |
1003421751 | Nicholas Ryan Tuttle | Nurse Anesthetist, Certified Registered | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-09-10 |
1356956122 | Caitlin Marie Clement | Nurse Anesthetist, Certified Registered | Medical Center Blvd, Winston Salem, NC 27103 | 2020-09-09 |
1376154591 | Lori Sansone Flores | Nurse Practitioner | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-08-11 |
1821609330 | Hannah Carey Walker | Physician Assistant | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-08-10 |
1447876883 | Raveena Mahesh Chhabria | Student in an Organized Health Care Education/Training Program | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-06-22 |
1780205930 | Jason Chin | Student in an Organized Health Care Education/Training Program | Medical Center Blvd, Winston Salem, NC 27157-1087 | 2020-04-29 |
1972122885 | Bryanna Dean Vesely | Student in an Organized Health Care Education/Training Program | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2020-04-10 |
1679102909 | Ameen Barghi | Student in an Organized Health Care Education/Training Program | Medical Center Blvd, Winston Salem, NC 27157-2803 | 2020-04-07 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255960241 | Alexandra Marie Balmaceda | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Center Pathology Dept, #1 Medical Center Blvd., Winston-salem, NC 27157 | 2020-04-02 |
1164916680 | Jorie Elizabeth Gatts | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Department of Pediatrics, Winston Salem, NC 27157 | 2018-06-18 |
1932606555 | Alexi Rae Ellington Webb | Student in an Organized Health Care Education/Training Program | Wake Forest School of Medicine, Dept of Psychiatry, Medical Center Blvd, Winston Salem, NC 27157 | 2018-04-10 |
1851896674 | Wasim Muhammad | Student in an Organized Health Care Education/Training Program | Wake Forest School of Medicine Dept. of Psychiatry, Medical Center Blvd, Winston Salem, NC 27157 | 2018-03-25 |
1336643535 | Phillip Martin Kostelic | Student in an Organized Health Care Education/Training Program | Anesthesiology - Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-salem, NC 27157 | 2018-03-21 |
1831693324 | Aleah Bond | Student in an Organized Health Care Education/Training Program | Anesthesiology Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-salem, NC 27157 | 2018-03-20 |
1134644859 | Ilan Binyamin Klein | Urology | Wake Forest Baptist Health, Department of Urology, Medical Center Boulevard, Winston-salem, NC 27157 | 2017-08-03 |
1023467529 | Edward John Doyle IIi | Student in an Organized Health Care Education/Training Program | Wake Forest School of Medicine Dept. of Otolaryngology, Watlington Hall 4th Fl. Medical Center Boulevard, Winston-salem, NC 27157 | 2016-06-07 |
1477917888 | Jordan Mae Burner | Student in an Organized Health Care Education/Training Program | Graduate Medical Education Office, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-salem, NC 27157 | 2016-04-12 |
1174900476 | Kate Elise Winterbottom | Speech-Language Pathologist | 4 Janeway Medical Center Blvd, Hearing and Speech, Winston Salem, NC 27157 | 2015-05-06 |
Find all providers in zip 27157 |
Taxonomy Code | 2080P0201X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
Specialization | Pediatric Allergy/Immunology |
A pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: title modified, definition added, source added] Additional Resources: A Certification of Special Qualifications (CSQ) is issued by the American Osteopathic Board of Pediatrics. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316107295 | Timothy Paul Moran | Pediatrics | 333 S Columbia St, Cb# 7231, Chapel Hill, NC 27599-0001 | 2008-06-13 |
1932193299 | Teresa Sue Bratton | Pediatrics | 1110 Sunset Dr, Greensboro, NC 27408-7214 | 2005-09-01 |
1164415477 | Allison L Freeman | Pediatrics | 3815 Ridge Crest Dr Ste 156-158, Saint James, NC 28461-9059 | 2005-08-23 |
1447877931 | Novant Medical Group, Inc. | Pediatrics | 6331 Carmel Rd Ste 102, Charlotte, NC 28226-8286 | 2020-06-30 |
1134765126 | Novant Medical Group, Inc. | Pediatrics | 201 Queens Rd, Charlotte, NC 28204-3217 | 2019-11-25 |
1669715413 | Puja Sood Rajani | Pediatrics | 6331 Carmel Rd Ste 102, Charlotte, NC 28226-8286 | 2013-03-30 |
1821288168 | Michelle L Hernandez | Pediatrics | 101 Manning Dr, Chapel Hill, NC 27599-0001 | 2007-08-01 |
1619042736 | Rebecca H. Buckley | Pediatrics | 4101 N Roxboro St, 362 Jones Building Duke University Medical Center, Durham, NC 27704-2121 | 2006-11-22 |
1033222864 | Amanda Dale-shall | Pediatrics | 1001 Blythe Blvd, Medical Center Plaza Suite 200, Charlotte, NC 28203-5866 | 2006-08-16 |
1568442242 | Bruce Kenneth Bacot | Pediatrics | 11 Vanderbilt Park Dr, Asheville, NC 28803-1700 | 2006-01-19 |
Find all providers with the same taxonomy |
City | WINSTON SALEM |
Zip Code | 27157 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.