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General NPI Number Information
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NPI Number | 1104847334
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Entity Type | Individual
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Provider Name | ALLISON J MOOSALLY MD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 3624 W MARKET ST SUITE 101
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City | FAIRLAWN
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State | OH
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Zip | 44333-4510
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Country | US
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Telephone | 330-665-0555
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Fax | 330-665-0556
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Provider Business Mailing Address
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Address Line | 3624 W MARKET ST SUITE 101
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City | FAIRLAWN
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State | OH
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Zip | 44333-4510
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Country | US
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Telephone | 330-665-0555
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Fax | 330-665-0556
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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 | 35088136
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 35088136
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License Number State | OH
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