MEDICARE: JOHN P. MOSCHELLO, MD, PC

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	OR0625	OTHER	CT	HEALTHNET
3	010023988CT09	OTHER	CT	ANTHEM BC/BS
4	023988	OTHER	CT	CONNECTICARE

General Provider Information

NPI Number	:	1700046083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN P. MOSCHELLO, MD, PC

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	:	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

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN P. MOSCHELLO
Credential	:	MD
Telephone Number	:	860-274-0674

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	07/17/2008

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