Provider Demographics
NPI:1013999259
Name:MOSKO, MARY K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:MOSKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9403 KENWOOD RD
Mailing Address - Street 2:SUITE C208
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6895
Mailing Address - Country:US
Mailing Address - Phone:513-891-5532
Mailing Address - Fax:513-891-5323
Practice Address - Street 1:9403 KENWOOD RD
Practice Address - Street 2:SUITE C208
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6895
Practice Address - Country:US
Practice Address - Phone:513-891-5532
Practice Address - Fax:513-891-5323
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069312M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2019096Medicaid
OHG54690Medicare UPIN
OH0827854Medicare PIN