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General NPI Number Information
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NPI Number | 1053435321
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Entity Type | Individual
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Provider Name | FRED M MOESLEIN MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 100 E CAMPUS VIEW BLVD STE 100
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City | COLUMBUS
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State | OH
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Zip | 43235-8628
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Country | US
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Telephone | 614-384-7177
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Fax | 614-947-8309
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Provider Business Mailing Address
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Address Line | 100 E CAMPUS VIEW BLVD STE 100
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City | COLUMBUS
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State | OH
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Zip | 43235-8628
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Country | US
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Telephone | 614-384-7177
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Fax | 614-947-8309
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MD431732
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 35.087689
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD431732
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License Number State | PA
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