=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245370006
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL M. MOSHOS D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2241 ROMBACH AVE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45177-1995
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-382-7785
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 CLARISSA AVE
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-299-2929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 34005373M
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | 34005373M
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 209800000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
-----------------------------------------------------
License Number | 34005373M
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------