Healthcare Provider Details

I. General information

NPI: 1306993985
Provider Name (Legal Business Name): QUINTON E MOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 FAIRGROVE AVE STE E
HAMILTON OH
45011-1930
US

IV. Provider business mailing address

1910 FAIRGROVE AVE STE E
HAMILTON OH
45011-1930
US

V. Phone/Fax

Practice location:
  • Phone: 513-868-0055
  • Fax: 513-297-7577
Mailing address:
  • Phone: 513-868-0055
  • Fax: 513-297-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35082846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: