Provider Demographics
NPI:1801127394
Name:MOSES, MEREDITH (PA)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:
Last Name:MOSES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:32 RAILROAD STREET
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217-1367
Mailing Address - Country:US
Mailing Address - Phone:207-824-2193
Mailing Address - Fax:207-824-3005
Practice Address - Street 1:32 RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-1367
Practice Address - Country:US
Practice Address - Phone:207-824-2193
Practice Address - Fax:207-824-3005
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA260363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant