Individual
AVA R MOSKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
443 CONGRESS ST, 2ND FLOOR, PORTLAND, ME 04101-3531
(207) 797-8881
(207) 773-1697
Mailing address
128 LAKESIDE AVE STE 301, BURLINGTON, VT 05401-5906
(802) 448-9719
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
015890
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060449
BLUE CROSS BLUE SHIELD
ME
05
—
290170099
—
ME
Enumeration date
11/04/2005
Last updated
07/21/2016
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