Provider Demographics
NPI:1073592978
Name:MOSCHELLO, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:MOSCHELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:594 MOUNT FAIR DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1661
Mailing Address - Country:US
Mailing Address - Phone:860-274-0674
Mailing Address - Fax:860-945-6614
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1741
Practice Address - Country:US
Practice Address - Phone:860-283-0286
Practice Address - Fax:203-575-5119
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00123988000OtherBLUE CARE FAMILY PLAN
CT061331790OtherCIGNA
CT061331790OtherUNITED HEALTHCARE
CT001239880Medicaid
CT061331790OtherGREAT WEST LIFE
CTOR0625OtherHEALTHNET
CT010023988CT09OtherANTHEM BC/BS
CT023988OtherCONNECTICARE
CT061331790OtherGREAT WEST LIFE
CT00123988000OtherBLUE CARE FAMILY PLAN