Provider Demographics
NPI:1477692853
Name:MOSES, ROBERT DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:334 CLYDE ST #3
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2910
Mailing Address - Country:US
Mailing Address - Phone:617-232-6830
Mailing Address - Fax:617-934-1936
Practice Address - Street 1:334 CLYDE ST # 3
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2910
Practice Address - Country:US
Practice Address - Phone:617-232-6830
Practice Address - Fax:617-232-6830
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA81406208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3147916Medicaid
MAG07131Medicare UPIN
MA3147916Medicaid