MEDICARE: MS. MEREDITH MOSES PA

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	363A00000X	Physician Assistant	PA260	ME
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1801127394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEREDITH MOSES PA

Provider Business Mailing Address
First Line	:	PO BOX 1367
Second Line	:	32 RAILROAD STREET
City	:	BETHEL
State	:	ME
Zip	:	04217-1367
Country	:	US
Telephone Number	:	207-824-2193
Fax Number	:	207-824-3005

Provider Business Practice Location Address
First Line	:	32 RAILROAD STREET
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-1367
Country	:	US
Telephone Number	:	207-824-2193
Fax Number	:	207-824-3005

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	02/08/2023

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