Provider Demographics
NPI:1437259405
Name:MOSHELL, ALAN NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:NATHAN
Last Name:MOSHELL
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:PO BOX 417480
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7480
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:9004 FERN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-425-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031347207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0631917OtherANTHEM
DCP00722679OtherRAILROAD MEDICARE
030016OtherUNITED HEALTHCARE
DC00140002OtherBCBS
VA5996643Medicaid
070004487OtherRAILROAD MEDICARE
030016OtherUNITED HEALTHCARE
192378Medicare ID - Type Unspecified
VA5996643Medicaid