Healthcare Provider Details

I. General information

NPI: 1033278809
Provider Name (Legal Business Name): KENNETT J. MOSES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SELLERS RD APT A
ANNAPOLIS MD
21402-1210
US

IV. Provider business mailing address

695 KINKAID RD
ANNAPOLIS MD
21402-1006
US

V. Phone/Fax

Practice location:
  • Phone: 206-317-9420
  • Fax:
Mailing address:
  • Phone: 410-293-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01052596A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01052596A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: