Provider Demographics
NPI:1821298761
Name:PETERS-HARRIS, MOSHA MASHAUN (MD)
Entity Type:Individual
Prefix:
First Name:MOSHA
Middle Name:MASHAUN
Last Name:PETERS-HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOSHA
Other - Middle Name:MASHAUN
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11868 COLLEGE BACKBONE ROAD
Mailing Address - Street 2:HAZEL HALL, #1062
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853
Mailing Address - Country:US
Mailing Address - Phone:410-651-8452
Mailing Address - Fax:410-651-7586
Practice Address - Street 1:116 PARKSIDE CIR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1635
Practice Address - Country:US
Practice Address - Phone:410-251-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD70961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910748Medicaid
AL009910689Medicaid
AL051559610Medicare PIN