Provider Demographics
NPI:1073519468
Name:MOSES, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26102-0779
Mailing Address - Country:US
Mailing Address - Phone:304-422-2523
Mailing Address - Fax:304-485-4466
Practice Address - Street 1:112 BRENTWOOD HTS
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8503
Practice Address - Country:US
Practice Address - Phone:304-422-2523
Practice Address - Fax:304-485-4466
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV18809207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0870942Medicare PIN