Provider Demographics
NPI:1508819970
Name:MOESCH, DEAN V (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:V
Last Name:MOESCH
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 15479
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2179
Mailing Address - Country:US
Mailing Address - Phone:912-629-0457
Mailing Address - Fax:912-629-0468
Practice Address - Street 1:1000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-3446
Practice Address - Country:US
Practice Address - Phone:912-629-0457
Practice Address - Fax:912-629-0468
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0278732085R0202X
SC147022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10075550OtherAMERIGROUP
GAP00316955OtherRAILROAD MEDICARE
GA52022342OtherBCBSGA
SCP00646674OtherRAILROAD MEDICARE
GA027873OtherLICENSE #
SCG27873Medicaid
SC14702OtherLICENSE #
N333567OtherWELLCARE
GA000412728KMedicaid
20058502OtherFIRST CHOICE
GA000412728KMedicaid
SCP00646674OtherRAILROAD MEDICARE
20058502OtherFIRST CHOICE