Healthcare Provider Details

I. General information

NPI: 1932185642
Provider Name (Legal Business Name): RONALD L MOSIELLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 PORTLAND RD STE 5
ARUNDEL ME
04046-8104
US

IV. Provider business mailing address

1232 PORTLAND RD STE 5
ARUNDEL ME
04046-8104
US

V. Phone/Fax

Practice location:
  • Phone: 207-464-9081
  • Fax: 866-870-3254
Mailing address:
  • Phone: 207-464-9081
  • Fax: 866-870-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1650
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: