Healthcare Provider Details

I. General information

NPI: 1245370006
Provider Name (Legal Business Name): DANIEL M. MOSHOS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 ROMBACH AVE
WILMINGTON OH
45177-1995
US

IV. Provider business mailing address

1800 CLARISSA AVE
KETTERING OH
45429-4215
US

V. Phone/Fax

Practice location:
  • Phone: 937-382-7785
  • Fax:
Mailing address:
  • Phone: 937-299-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34005373M
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number34005373M
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number34005373M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: