Provider Demographics
NPI:1700046083
Name:JOHN P. MOSCHELLO, MD, PC
Entity Type:Organization
Organization Name:JOHN P. MOSCHELLO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOSCHELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-274-0674
Mailing Address - Street 1:594 MOUNT FAIR DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1661
Mailing Address - Country:US
Mailing Address - Phone:860-274-0674
Mailing Address - Fax:860-945-6614
Practice Address - Street 1:594 MOUNT FAIR DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-1661
Practice Address - Country:US
Practice Address - Phone:860-274-0674
Practice Address - Fax:860-945-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00123988000OtherBLUE CARE FAMILY PLAN
CTOR0625OtherHEALTHNET
CT010023988CT09OtherANTHEM BC/BS
CT023988OtherCONNECTICARE
CT010023988CT09OtherANTHEM BC/BS
CTOR0625OtherHEALTHNET