Provider Demographics
NPI:1417976929
Name:MOSES, LEONARD CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:CARL
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8443 KINTAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5180
Mailing Address - Country:US
Mailing Address - Phone:804-748-3608
Mailing Address - Fax:
Practice Address - Street 1:111F HUNTER HOLMES MCGUIRE MEDICAL CTR
Practice Address - Street 2:1201 BROAD ROCK BLVD
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5605
Practice Address - Fax:804-675-5472
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101043446207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF30928Medicare UPIN