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Individual
MR. ROBERT T MOOSALLY
Active
Individual
MR. ROBERT T MOOSALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
34007710
OH
207Q00000X
Family Medicine Physician
Primary
34007710
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000383091
ANTHEM
OH
01
—
000000385522
ANTHEM
OH
01
—
001965500-0003
PENNSYLVANIA MEDICAID
OH
05
—
2374989
—
OH
Enumeration date
12/16/2005
Last updated
01/14/2026
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