Provider Demographics
NPI:1801922547
Name:MOSS, DAVID RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSELL
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:BOX 298
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-6044
Mailing Address - Fax:617-636-8384
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 298
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-6044
Practice Address - Fax:617-636-8384
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA239306207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083132/AMedicaid
MA001320301Medicare PIN