MEDICARE: ELIZABETH HART MOSELEY 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	2085R0202X	Diagnostic Radiology Physician	0101052980	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1578547618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HART MOSELEY MD

Provider Business Mailing Address
First Line	:	PO BOX 844555
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02284-4555
Country	:	US
Telephone Number	:	540-891-8730
Fax Number	:	540-891-5742

Provider Business Practice Location Address
First Line	:	110 KINGSLEY LN
Second Line	:	#305
City	:	NORFOLK
State	:	VA
Zip	:	23505-4614
Country	:	US
Telephone Number	:	757-889-5422
Fax Number	:	757-889-5450

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	07/07/2016

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