Provider Demographics
NPI:1730341421
Name:KOUSSA, GHASSAN JAMIL (MD)
Entity type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:JAMIL
Last Name:KOUSSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2668
Mailing Address - Country:US
Mailing Address - Phone:315-361-7472
Mailing Address - Fax:315-361-7473
Practice Address - Street 1:600 SENECA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2668
Practice Address - Country:US
Practice Address - Phone:315-361-7472
Practice Address - Fax:315-361-7473
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16076207RC0200X, 207RP1001X
TXT9727207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04598138Medicaid