Healthcare Provider Details

I. General information

NPI: 1033110572
Provider Name (Legal Business Name): DAVID ALEXANDER MOSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL PARK SUITE 211
WHEELING WV
26003-6391
US

IV. Provider business mailing address

30 MEDICAL PARK SUITE 211
WHEELING WV
26003-6391
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-3300
  • Fax: 304-242-8964
Mailing address:
  • Phone: 304-242-3300
  • Fax: 304-242-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21710
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: