Provider Demographics
NPI:1962475806
Name:MOSTER, MARLENE R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:R
Last Name:MOSTER
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 1:7800 W OAKLAND DRIVE
Mailing Address - Street 2:UNIT 205
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6741
Mailing Address - Country:US
Mailing Address - Phone:954-859-2020
Mailing Address - Fax:954-736-4344
Practice Address - Street 1:7800 W OAKLAND PARK BLVD UNIT 205
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6741
Practice Address - Country:US
Practice Address - Phone:954-859-2020
Practice Address - Fax:954-736-4344
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024149E207W00000X, 207WX0009X
DEC1-0003844207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000969219-0003Medicaid
PA000969219-0005Medicaid
NJ0797405Medicaid
PA000969219-0006Medicaid
PA000969219-0001Medicaid
PA000969219-0006Medicaid
PA180030619Medicare PIN
PA000969219-0005Medicaid