Individual
LAURA MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 BROOKLINE AVE, BOSTON, MA 02215-5450
(617) 632-3000
Mailing address
450 BROOKLINE AVE, BOSTON, MA 02215-5418
(617) 632-3000
(617) 278-6965
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110178056A
—
MA
Enumeration date
08/26/2021
Last updated
04/04/2022
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