Healthcare Provider Details

I. General information

NPI: 1659304871
Provider Name (Legal Business Name): ROBERT LESLIE MOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BUSINESS CENTER DRIVE
REISTERSTOWN MD
21136
US

IV. Provider business mailing address

114 BUSINESS CENTER DRIVE
REISTERSTOWN MD
21136
US

V. Phone/Fax

Practice location:
  • Phone: 410-833-2772
  • Fax: 410-526-4897
Mailing address:
  • Phone: 410-833-2772
  • Fax: 410-526-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0032882
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD32882
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD0032882
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: