Provider Demographics
NPI:1467552919
Name:MOSS, DENNIS MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:MOSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9655 LONGSWAMP ROAD
Mailing Address - Street 2:
Mailing Address - City:MERTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19539
Mailing Address - Country:US
Mailing Address - Phone:610-682-4944
Mailing Address - Fax:610-682-6125
Practice Address - Street 1:9655 LONGSWAMP ROAD
Practice Address - Street 2:
Practice Address - City:MERTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19539-8800
Practice Address - Country:US
Practice Address - Phone:610-682-4944
Practice Address - Fax:610-682-6125
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05008856-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015547380001Medicaid
G07894Medicare UPIN
PA0015547380001Medicaid