Individual
MARTHA E MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1250 HANCOCK ST, INTERNAL MEDICINE, QUINCY, MA 02169-4339
(617) 774-0840
(617) 774-0882
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
73738
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3078728
—
MA
Enumeration date
04/25/2006
Last updated
06/27/2011
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