Healthcare Provider Details

I. General information

NPI: 1689773749
Provider Name (Legal Business Name): PAULA MOSLEY DUPEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA V MOSLEY PA

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW ROUTING NUMBER 151W
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

16412 EIDER ST
BOWIE MD
20716-3241
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax: 202-745-3002
Mailing address:
  • Phone: 202-745-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA30086
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: