Healthcare Provider Details

I. General information

NPI: 1295816551
Provider Name (Legal Business Name): SAMUEL M MOSKOWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAMBRIDGE STREET, CPZS-556 DIVISION OF PEDIATRIC PULMONARY MEDICINE, MGH
BOSTON MA
02114
US

IV. Provider business mailing address

175 CAMBRIDGE ST., CPZS-556 DIVISION OF PEDIATRIC PULMONARY MEDICINE, MGH
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-7232
  • Fax: 617-643-7234
Mailing address:
  • Phone: 617-643-7232
  • Fax: 617-643-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD00035368
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number236616
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: