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NPI Code Detail

MEDICARE: CARLOS G MOSCOSO M.D., PH.D.

MEDICARE: CARLOS G MOSCOSO M.D., PH.D.
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
1207RG0100XGastroenterology PhysicianMD61079382WA

General Provider Information

NPI Number : 1083148969
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLOS G MOSCOSO M.D., PH.D.
Provider Business Mailing Address
First Line : PO BOX 5127
Second Line :
City : EVERETT
State : WA
Zip : 98206-5127
Country : US
Telephone Number : 206-860-5414
Fax Number : 425-252-4441
Provider Business Practice Location Address
First Line : 9709 3RD AVE NE
Second Line :
City : SEATTLE
State : WA
Zip : 98115-2062
Country : US
Telephone Number : 206-329-1760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2017
Last Update Date : 12/08/2025

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