MEDICARE: KATHRYN E. MOSMAN M.G.C.

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	170300000X	Genetic Counselor (M.S.)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2005193	OTHER	TX	ABMG-ABGC CERTIFICATE #

General Provider Information

NPI Number	:	1215064514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN E. MOSMAN M.G.C.

Provider Business Mailing Address
First Line	:	6500 NORTH MOPAC EXPRESSWAY
Second Line	:	BUILDING 1, SUITE 1205
City	:	AUSTIN
State	:	TX
Zip	:	78731
Country	:	US
Telephone Number	:	512-206-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 CHESTNUT ST
Second Line	:	SUITE 1250
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4414
Country	:	US
Telephone Number	:	215-351-2331
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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