Provider Demographics
NPI:1982893905
Name:MOSES, TAIJA N (PA-C)
Entity Type:Individual
Prefix:
First Name:TAIJA
Middle Name:N
Last Name:MOSES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 WILMINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105
Mailing Address - Country:US
Mailing Address - Phone:724-656-8940
Mailing Address - Fax:724-656-8942
Practice Address - Street 1:3105 WILMINGTON ROAD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105
Practice Address - Country:US
Practice Address - Phone:724-656-8940
Practice Address - Fax:724-656-8942
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053105363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical