1891743068 NPI number — DR. DAVID A MOSS M.D.

Table of content: DR. DAVID A MOSS M.D. (NPI 1891743068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891743068 NPI number — DR. DAVID A MOSS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSS
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891743068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 ATWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
JOHNSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02919-3228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-351-6200
Provider Business Mailing Address Fax Number:
401-351-6201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 ATWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
JOHNSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02919-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-351-6200
Provider Business Practice Location Address Fax Number:
401-351-6201
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  MD09787 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA48450 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 050397249 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050397249 . This is a "WORKERS COMPENSTION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050397249 . This is a "MULTIPLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050397249 . This is a "PEQUOT PLUS HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103714900 . This is a "U.S. DEPT. OF LABOR-WC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23922 . This is a "NEIGHBORHOOD HEALTH PLANS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2723 . This is a "BC BS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: CD1829 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 402836 . This is a "BLUECHIP OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: R000315 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0860497-002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7278316 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 778764 . This is a "TUFTS HEALTH PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 050397249 . This is a "FIRST HLTH/COVENTRY/HCVM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9002723 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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