Provider Demographics
NPI:1801956057
Name:MOSELY, LINDA HAYS (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:HAYS
Last Name:MOSELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVE STE 419
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1306
Mailing Address - Country:US
Mailing Address - Phone:703-481-1811
Mailing Address - Fax:703-921-1840
Practice Address - Street 1:4660 KENMORE AVE STE 419
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:703-481-1811
Practice Address - Fax:703-921-1840
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001 9138OtherCAREFIRST BCBS PROVIDER #
VA541345876OtherTAX ID #
VAAETNA PPOOther4054272
VA4054272OtherAETNA PPO
VA149493500OtherDEPT OF LABOR ID #
VA066131OtherANTHEM PROVEDER #
VA170055Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
VA0001 9138OtherCAREFIRST BCBS PROVIDER #