Healthcare Provider Details

I. General information

NPI: 1962475806
Provider Name (Legal Business Name): MARLENE R MOSTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 11/22/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OAKLAND PARK BLVD UNIT 205
SUNRISE FL
33351-6741
US

IV. Provider business mailing address

7800 W OAKLAND DRIVE UNIT 205
SUNRISE FL
33351-6741
US

V. Phone/Fax

Practice location:
  • Phone: 954-859-2020
  • Fax: 954-736-4344
Mailing address:
  • Phone: 954-859-2020
  • Fax: 954-736-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD024149E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC1-0003844
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD024149E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberC1-0003844
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: