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NPI Code Detail

MEDICARE: DR. FRED M MOESLEIN MD, PHD

MEDICARE: DR. FRED M MOESLEIN MD, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0204XVascular & Interventional Radiology PhysicianMD431732MD
22085R0204XVascular & Interventional Radiology Physician35.087689OH
3174400000XSpecialistMD431732PA

General Provider Information

NPI Number : 1053435321
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED M MOESLEIN MD, PHD
Provider Business Mailing Address
First Line : 100 E CAMPUS VIEW BLVD STE 100
Second Line :
City : COLUMBUS
State : OH
Zip : 43235-8628
Country : US
Telephone Number : 614-384-7177
Fax Number : 614-947-8309
Provider Business Practice Location Address
First Line : 100 E CAMPUS VIEW BLVD STE 100
Second Line :
City : COLUMBUS
State : OH
Zip : 43235-8628
Country : US
Telephone Number : 614-384-7177
Fax Number : 614-947-8309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 06/26/2024

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