Provider Demographics
NPI:1295791374
Name:MOSKOWITZ, MARK SANDERS (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SANDERS
Last Name:MOSKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1089 X RAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7489
Mailing Address - Country:US
Mailing Address - Phone:704-864-8377
Mailing Address - Fax:
Practice Address - Street 1:1089 X RAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7489
Practice Address - Country:US
Practice Address - Phone:704-864-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-24020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC256264OtherMAMSI
NC61169OtherBCBS
NC4451102OtherAETNA/USHC
NC0082390-002OtherCIGNA
NC011610OtherPARTNERS
NC17-41477OtherUNITED HEALTHCARE
NC2029701OtherAETNA/USHC HMO
NC8961169Medicaid
NC28449OtherMEDCOST
NC011610OtherPARTNERS
NC0082390-002OtherCIGNA