Provider Demographics
NPI:1568121101
Name:MOZA, DASHA (MD)
Entity Type:Individual
Prefix:
First Name:DASHA
Middle Name:
Last Name:MOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4136
Mailing Address - Fax:585-922-5761
Practice Address - Street 1:1425 PORTLAND AVE; WILSON BUILDING
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3011
Practice Address - Country:US
Practice Address - Phone:585-922-4136
Practice Address - Fax:585-922-5761
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY312579207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology