Provider Demographics
NPI: | 1508094392 |
---|---|
Name: | MOSCOL, GIANCARLO (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | GIANCARLO |
Middle Name: | |
Last Name: | MOSCOL |
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: | 925 CHESTNUT ST |
Mailing Address - Street 2: | SUITE 320A |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19107-4216 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1515 HOLCOMBE BLVD |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77030-4000 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-792-2991 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-06-30 |
Last Update Date: | 2017-11-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MT195239 | 207R00000X |
PA | MD446435 | 207R00000X |
TX | Q0319 | 207RX0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0311626 | Medicaid | |
PA | 102747580 | Medicaid | |
TX | 375329501 | Medicaid | |
PA | 244875 | Medicare PIN |