Provider Demographics
NPI:1841401254
Name:MOOSBRUGGER, EMILY A (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:MOOSBRUGGER
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 1:4700 E GALBRAITH RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2726
Mailing Address - Country:US
Mailing Address - Phone:513-924-8860
Mailing Address - Fax:513-924-8862
Practice Address - Street 1:4700 E GALBRAITH RD
Practice Address - Street 2:STE 105
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2726
Practice Address - Country:US
Practice Address - Phone:513-924-8860
Practice Address - Fax:513-924-8862
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57011706207R00000X
OH35.095309207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3068380Medicaid
OHH073561Medicare PIN