Provider Demographics
NPI:1750312518
Name:MOSLEY, MARK RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 GUYS RUN ROAD
Mailing Address - Street 2:PO BOX 11460
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238
Mailing Address - Country:US
Mailing Address - Phone:412-435-0005
Mailing Address - Fax:412-435-0003
Practice Address - Street 1:320 GUYS RUN ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238
Practice Address - Country:US
Practice Address - Phone:412-435-0005
Practice Address - Fax:412-435-0003
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019749E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010867Medicaid
OH0867405Medicaid
PA0007281080001Medicaid
PAP00469281Medicare PIN
PA148956NJKMedicare PIN
PA0007281080001Medicaid