MEDICARE: MRS. RHIANNON E MOSCARELLI IDC

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	1710I1002X	Independent Duty Corpsman

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1249666358	OTHER		DOD ID

General Provider Information

NPI Number	:	1760809503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHIANNON E MOSCARELLI IDC

Provider Business Mailing Address
First Line	:	USS ABRAHAM LINCOLN (CVN 72)
Second Line	:	UNIT 100349 BOX 1
City	:	FPO AE
State	:	VA
Zip	:	09520-2872
Country	:	US
Telephone Number	:	757-534-0097
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS ABRAHAM LINCOLN (CVN 72)
Second Line	:	UNIT 100349 BOX 1
City	:	FPO
State	:	AE
Zip	:	09520-2872
Country	:	US
Telephone Number	:	757-534-0097
Fax Number	:

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

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	09/13/2016

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