Provider Demographics
NPI:1396217055
Name:LAWAL, MOSHOOD
Entity Type:Individual
Prefix:
First Name:MOSHOOD
Middle Name:
Last Name:LAWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARIGOLD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3866
Mailing Address - Country:US
Mailing Address - Phone:401-228-5478
Mailing Address - Fax:401-223-6865
Practice Address - Street 1:4 MARIGOLD CIR
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3866
Practice Address - Country:US
Practice Address - Phone:401-228-5478
Practice Address - Fax:401-223-6865
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI9818754172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver