Provider Demographics
NPI:1205965019
Name:MOSCHONAS, CONSTANTINE (MD)
Entity type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:MOSCHONAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9746 N 90TH PL
Mailing Address - Street 2:#203
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5085
Mailing Address - Country:US
Mailing Address - Phone:480-614-0707
Mailing Address - Fax:480-614-0353
Practice Address - Street 1:9746 N 90TH PL
Practice Address - Street 2:#203
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5085
Practice Address - Country:US
Practice Address - Phone:480-614-0707
Practice Address - Fax:480-614-0353
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ199152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCKFMOtherMEDICARE GROUP ID #
AZ162321-01Medicaid
AZ1Z2076OtherHEALTHNET ID #
AZ4330420OtherAETNA ID #
AZAZ0344440OtherBCBS ID #
AZ4230300OtherCIGNA ID #
AZ05-00060OtherUNITEDHEALTHCARE ID #
AZ05-00060OtherUNITEDHEALTHCARE ID #
AZZ13WCKFM03Medicare PIN