MEDICARE: ISAAC EROMOSELE MOSES

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	374U00000X	Home Health Aide	HHA11062	DC

General Provider Information

NPI Number	:	1891188330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC EROMOSELE MOSES

Provider Business Mailing Address
First Line	:	3823 64TH AVE
Second Line	:	APT # 4
City	:	LANDOVERHILLS
State	:	MD
Zip	:	20784-1876
Country	:	US
Telephone Number	:	240-413-0204
Fax Number	:

Provider Business Practice Location Address
First Line	:	3823 64TH AVE
Second Line	:	APT # 4
City	:	LANDOVER HILLS
State	:	MD
Zip	:	20784-1830
Country	:	US
Telephone Number	:	240-413-0204
Fax Number	:

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	06/21/2016

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