Provider Demographics
NPI:1477583284
Name:MOSS, EDWARD G (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER UNIVERISTY RADIOLOGY
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2383
Practice Address - Fax:836-365-0472
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA025688002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0079795000OtherAMERIHEALTH/KEYSTONE/IBC
NJ105526OtherAMERIHEALTH PPO/ PA BS
NJ105526OtherPA BS HIGHMARK
NJ60003013OtherHORIZON NJ HEALTH
NJ18880OtherUNIVERSITY HEALTH PLAN
NJ4949470OtherCIGNA
NJP3737787OtherOXFORD
NJ2408601Medicaid
NJ1829988OtherUNITED HEALTHCARE
NJP00092391OtherRR MEDICARE
NJCA000023703OtherAMERICHOICE
PA000697834 0001Medicaid
NJ3396096OtherAETNA
NJP3737787OtherOXFORD
PA000697834 0001Medicaid