Provider Demographics
NPI:1326640574
Name:MOSQUEDA GARCIA, AGUSTIN ROGELIO (MD)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:ROGELIO
Last Name:MOSQUEDA GARCIA
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 1:200 BARR HARBOR DR STE 2004
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2977
Mailing Address - Country:US
Mailing Address - Phone:484-533-7904
Mailing Address - Fax:
Practice Address - Street 1:300 CAPTAIN ROBINSON DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-9618
Practice Address - Country:US
Practice Address - Phone:302-379-9676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN026526207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease