MEDICARE: MR. ROBERT T MOOSALLY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34007710	OH
2	207P00000X	Emergency Medicine Physician	34007710	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000385522	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000383091	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1013993419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT T MOOSALLY DO

Provider Business Mailing Address
First Line	:	2537 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6257
Country	:	US
Telephone Number	:	330-656-5911
Fax Number	:	330-656-5901

Provider Business Practice Location Address
First Line	:	2537 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6257
Country	:	US
Telephone Number	:	330-460-5514
Fax Number	:	330-595-4366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	01/14/2026

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Directions to “ MR. ROBERT T MOOSALLY DO” Practice Location

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