1801956057 NPI number — DR. LINDA HAYS MOSELY M.D.

Table of content: DR. LINDA HAYS MOSELY M.D. (NPI 1801956057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801956057 NPI number — DR. LINDA HAYS MOSELY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSELY
Provider First Name:
LINDA
Provider Middle Name:
HAYS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1801956057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4660 KENMORE AVE STE 419
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22304-1306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-481-1811
Provider Business Mailing Address Fax Number:
703-921-1840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4660 KENMORE AVE STE 419
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-481-1811
Provider Business Practice Location Address Fax Number:
703-921-1840
Provider Enumeration Date:
12/11/2006

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: 174400000X , with the licence number:  0101030954 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001 9138 . This is a "CAREFIRST BCBS PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 541345876 . This is a "TAX ID #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: AETNA PPO . This is a "4054272" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4054272 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 149493500 . This is a "DEPT OF LABOR ID #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 066131 . This is a "ANTHEM PROVEDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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