MEDICARE: DR. JOHN P MOSCHELLO MD

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
1	207R00000X	Internal Medicine Physician	023988	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00123988000	OTHER	CT	BLUE CARE FAMILY PLAN
2	061331790	OTHER	CT	CIGNA
3	061331790	OTHER	CT	UNITED HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	061331790	OTHER	CT	GREAT WEST LIFE
6	OR0625	OTHER	CT	HEALTHNET
7	010023988CT09	OTHER	CT	ANTHEM BC/BS
8	023988	OTHER	CT	CONNECTICARE

General Provider Information

NPI Number	:	1073592978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN P MOSCHELLO MD

Provider Business Mailing Address
First Line	:	594 MOUNT FAIR DR
Second Line	:
City	:	WATERTOWN
State	:	CT
Zip	:	06795-1661
Country	:	US
Telephone Number	:	860-274-0674
Fax Number	:	860-945-6614

Provider Business Practice Location Address
First Line	:	130 S MAIN ST
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1741
Country	:	US
Telephone Number	:	860-283-0286
Fax Number	:	203-575-5119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	06/15/2018

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Directions to “ DR. JOHN P MOSCHELLO MD” Practice Location

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