Provider Demographics
NPI:1578541553
Name:MOSHER, JODEE LYN (MD)
Entity Type:Individual
Prefix:MS
First Name:JODEE
Middle Name:LYN
Last Name:MOSHER
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 1:50 MARQUIS RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6477
Mailing Address - Country:US
Mailing Address - Phone:207-865-6131
Mailing Address - Fax:207-865-9399
Practice Address - Street 1:50 MARQUIS RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6477
Practice Address - Country:US
Practice Address - Phone:207-865-6131
Practice Address - Fax:207-865-9399
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12470207R00000X
MEMD18327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204885Medicaid
MERE801503Medicare PIN
MEP01059139Medicare PIN