Healthcare Provider Details

I. General information

NPI: 1689993339
Provider Name (Legal Business Name): ROBERT KEITH MOSER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 S BROAD ST 3RD FLOOR
PHILADELPHIA PA
19145-4418
US

IV. Provider business mailing address

2410 S BROAD ST 3RD FLOOR
PHILADELPHIA PA
19145-4418
US

V. Phone/Fax

Practice location:
  • Phone: 215-462-6600
  • Fax: 215-462-2650
Mailing address:
  • Phone: 215-462-6600
  • Fax: 215-462-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA001788L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: