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General NPI Number Information
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NPI Number | 1063471050
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Entity Type | Individual
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Provider Name | JESSICA SUZANNE MOSHER MD
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Gender | Female
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 62 WALNUT ST STE 1
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City | WELLESLEY HILLS
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State | MA
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Zip | 02481-2109
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Country | US
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Telephone | 781-400-0469
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Fax | 617-604-2168
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Provider Business Mailing Address
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Address Line | 68 WELLESLEY RD
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City | BELMONT
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State | MA
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Zip | 02478-2125
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Country | US
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Telephone | 617-710-6585
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Fax | 617-710-6585
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 217725
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number | 217725
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 217725
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 217725
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 217725
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License Number State | MA
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