Healthcare Provider Details

I. General information

NPI: 1184856205
Provider Name (Legal Business Name): CHAD ROBERT MOSER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5281
  • Fax: 513-558-5791
Mailing address:
  • Phone: 513-245-3667
  • Fax: 513-475-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.002957
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: