Healthcare Provider Details

I. General information

NPI: 1811335011
Provider Name (Legal Business Name): PETER T MOSKAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 02/15/2024
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 KEMPSVILLE RD STE 201 BLDG A SUITE 201
NORFOLK VA
23502
US

IV. Provider business mailing address

171 KEMPSVILLE ROAD, BLDG. A
NORFOLK VA
23502
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-6550
  • Fax: 757-668-6544
Mailing address:
  • Phone: 757-668-6550
  • Fax: 757-668-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number0101270019
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: