MEDICARE: QUINTON E MOSS MD

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	2084P0800X	Psychiatry Physician	35082846	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1225260888	OTHER	OH	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306993985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUINTON E MOSS MD

Provider Business Mailing Address
First Line	:	1910 FAIRGROVE AVE STE E
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-1930
Country	:	US
Telephone Number	:	513-868-0055
Fax Number	:	513-297-7577

Provider Business Practice Location Address
First Line	:	1910 FAIRGROVE AVE STE E
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-1930
Country	:	US
Telephone Number	:	513-868-0055
Fax Number	:	513-297-7577

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/27/2020

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Directions to “ QUINTON E MOSS MD” Practice Location

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