Provider Demographics
NPI:1780645622
Name:MOSTER, MARY RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:RUTH
Last Name:MOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:OLDENBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47036-0130
Mailing Address - Country:US
Mailing Address - Phone:812-932-0475
Mailing Address - Fax:
Practice Address - Street 1:22109 VINE ST
Practice Address - Street 2:
Practice Address - City:OLDENBURG
Practice Address - State:IN
Practice Address - Zip Code:47036-9749
Practice Address - Country:US
Practice Address - Phone:812-932-0475
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041538A103TC0700X
OH5618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000317106Medicare UPIN
186044Medicare UPIN
177150Medicare ID - Type Unspecified
7440308Medicare UPIN