=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053358184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. MICHAEL ARTHUR MOSS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 09/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 724 DELAWARE AVE
-----------------------------------------------------
City | FOUNTAIN HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18015-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-257-8715
-----------------------------------------------------
Fax | 800-819-1655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 OBERLIN AVE
-----------------------------------------------------
City | SWARTHMORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19081-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-544-8679
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS007161L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------