Healthcare Provider Details

I. General information

NPI: 1861228736
Provider Name (Legal Business Name): MARIA MOSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 UNIVERSITY DR
WEST LIBERTY WV
26074-1082
US

IV. Provider business mailing address

170 MILLER ST
WHEELING WV
26003-5916
US

V. Phone/Fax

Practice location:
  • Phone: 304-336-5000
  • Fax:
Mailing address:
  • Phone: 304-231-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3045
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: