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General NPI Number Information
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NPI Number | 1780829168
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Entity Type | Individual
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Provider Name | BRYAN EDWARD MOSORA D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 1755 N MECKLENBURG AVE
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City | SOUTH HILL
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State | VA
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Zip | 23970-4080
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Country | US
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Telephone | 434-584-5025
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 RXR PLZ FL 13
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City | UNIONDALE
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State | NY
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Zip | 11556-1301
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Country | US
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Telephone | 516-453-0435
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LT22008
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102206048
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP60864272
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License Number State | WA
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