Provider Demographics
NPI:1821134925
Name:MOSELEY, KENDALL F (MD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:F
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 EASTERN AVE
Mailing Address - Street 2:MASON F. LORD CENTER TOWER, SUITE 4300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2734
Mailing Address - Country:US
Mailing Address - Phone:410-550-6497
Mailing Address - Fax:410-550-6864
Practice Address - Street 1:5200 EASTERN AVE
Practice Address - Street 2:MASON F. LORD CENTER TOWER, SUITE 4300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2734
Practice Address - Country:US
Practice Address - Phone:410-550-6497
Practice Address - Fax:410-550-6864
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD712486207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD223902ZAC3Medicare PIN