Provider Demographics
NPI:1508956343
Name:MOSCA, CRYSTAL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:L
Last Name:MOSCA
Suffix:
Gender:F
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 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:877-220-9811
Mailing Address - Fax:330-225-5394
Practice Address - Street 1:5133 RIDGE RD # 1
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9708
Practice Address - Country:US
Practice Address - Phone:330-239-4455
Practice Address - Fax:330-239-4456
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2704452Medicaid
OH2704452Medicaid