Provider Demographics
NPI:1760462261
Name:MOSES, WENDELL (MD)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:
Last Name:MOSES
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 1:900 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2101
Mailing Address - Country:US
Mailing Address - Phone:423-778-5437
Mailing Address - Fax:423-778-7507
Practice Address - Street 1:900 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2101
Practice Address - Country:US
Practice Address - Phone:423-778-5437
Practice Address - Fax:423-778-7507
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35885207XP3100X
NC313382086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Not Answered2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A51888Medicare UPIN