Provider Demographics
NPI:1023080934
Name:MOSER, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MOSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 JACKSON PARK RD
Mailing Address - Street 2:KANNAPOLIS INT MED
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3657
Mailing Address - Country:US
Mailing Address - Phone:704-932-1155
Mailing Address - Fax:704-932-3500
Practice Address - Street 1:559 JACKSON PARK RD
Practice Address - Street 2:KANNAPOLIS INT MED
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3657
Practice Address - Country:US
Practice Address - Phone:704-932-1155
Practice Address - Fax:704-932-3500
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009OtherMEDICARE PTAN, GROUP
NC8960917Medicaid
NC8960917Medicaid
NC232009OtherMEDICARE PTAN, GROUP