Basic Information
| Provider Information | |||||||||
| NPI: | 1891743068 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1524 ATWOOD AVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029193228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013516200 | ||||||||
| FaxNumber: | 4013516201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1524 ATWOOD AVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029193228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013516200 | ||||||||
| FaxNumber: | 4013516201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 04/08/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | MD09787 | RI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | AA48450 | 01 | MA | HARVARD PILGRIM HEALTH | OTHER | 050397249 | 01 | UNITEDHEALTHCARE | OTHER | 050397249 | 01 | WORKERS COMPENSTION | OTHER | 050397249 | 01 | MULTIPLANS | OTHER | 050397249 | 01 | PEQUOT PLUS HEALTH PLANS | OTHER | 103714900 | 01 | U.S. DEPT. OF LABOR-WC | OTHER | 23922 | 01 | RI | NEIGHBORHOOD HEALTH PLANS | OTHER | 2723 | 01 | RI | BC BS OF RI | OTHER | CD1829 | 01 | RAILROAD MEDICARE | OTHER | 402836 | 01 | RI | BLUECHIP OF RI | OTHER | R000315 | 01 | TRICARE | OTHER | 0860497-002 | 01 | CIGNA | OTHER | 7278316 | 01 | AETNA | OTHER | 778764 | 01 | MA | TUFTS HEALTH PLANS | OTHER | 050397249 | 01 | FIRST HLTH/COVENTRY/HCVM | OTHER | 9002723 | 05 | RI | MEDICAID |