Provider Demographics
NPI:1912328006
Name:GMOSCH MD, LTD
Entity Type:Organization
Organization Name:GMOSCH MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSCH
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:814-765-1681
Mailing Address - Street 1:1036 PARK AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-4028
Mailing Address - Country:US
Mailing Address - Phone:814-765-1681
Mailing Address - Fax:814-765-7756
Practice Address - Street 1:1036 PARK AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-4028
Practice Address - Country:US
Practice Address - Phone:814-765-1681
Practice Address - Fax:814-765-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA181072OtherBLUE CROSS
PA0010174600001Medicaid
PA0010174600001Medicaid