Provider Demographics
NPI:1710202916
Name:MOSCONA, JOHN C
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:MOSCONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:MOSCONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:900 W 38TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1141
Mailing Address - Country:US
Mailing Address - Phone:512-206-3600
Mailing Address - Fax:512-206-3604
Practice Address - Street 1:900 W 38TH ST STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1141
Practice Address - Country:US
Practice Address - Phone:512-206-3600
Practice Address - Fax:512-206-3604
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205305208M00000X, 207R00000X
TXS6547207RI0011X
CODR.0053762207R00000X, 208M00000X
NC2019-00863207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01348203OtherRAIL ROAD MEDICARE
CO60058234Medicaid
LA2108221Medicaid
LA2108221Medicaid
LA293865YJB9Medicare PIN