Provider Demographics
NPI:1104825512
Name:MOSES, MELIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:MELIN
Middle Name:J
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1401
Mailing Address - Country:US
Mailing Address - Phone:304-781-3589
Mailing Address - Fax:304-781-3592
Practice Address - Street 1:2959 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1401
Practice Address - Country:US
Practice Address - Phone:304-781-3589
Practice Address - Fax:304-781-3592
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055289000Medicaid
WV001721906OtherBC/BS
WVMO0854202Medicare PIN
WV001721906OtherBC/BS