Individual
JOSEPH J. MOISAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF NEUROSURGERY, WORCESTER, MA 01655-0002
(508) 334-0605
(508) 334-5074
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00508
RI
363A00000X
Physician Assistant
Primary
PA3806
MA
363AS0400X
Surgical Physician Assistant
PA3806
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001697301
MEDICARE PTAN
RI
05
—
JM84255
—
RI
Enumeration date
07/21/2009
Last updated
09/03/2025
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