MEDICARE: MOSEN ALAVI M.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
1	207RC0000X	Cardiovascular Disease Physician	MD035334Y	PA

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

General Provider Information

NPI Number	:	1699730382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOSEN ALAVI M.D.

Provider Business Mailing Address
First Line	:	531 CONSHOHOCKEN STATE RD
Second Line	:
City	:	GLADWYNE
State	:	PA
Zip	:	19035-1423
Country	:	US
Telephone Number	:	610-645-8312
Fax Number	:	215-707-1157

Provider Business Practice Location Address
First Line	:	100 E LEHIGH AVE
Second Line	:	SUITE 204
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1000
Country	:	US
Telephone Number	:	215-707-1160
Fax Number	:	215-707-1157

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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