Provider Demographics
NPI:1609183961
Name:MOSER, JAMIE (LDN, RD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MOSER
Suffix:
Gender:F
Credentials:LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WISSAHICKON AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:267-597-3600
Mailing Address - Fax:267-597-3622
Practice Address - Street 1:6120-B WOODLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142
Practice Address - Country:US
Practice Address - Phone:215-727-4721
Practice Address - Fax:215-726-4507
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered