Provider Demographics
NPI:1740302017
Name:ENOCH, MICHAEL MOZES (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MOZES
Last Name:ENOCH
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 1:6948 COPPERBEND LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1634
Mailing Address - Country:US
Mailing Address - Phone:410-484-0202
Mailing Address - Fax:410-244-1666
Practice Address - Street 1:1261 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2666
Practice Address - Country:US
Practice Address - Phone:410-244-1717
Practice Address - Fax:410-244-1666
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine