Provider Demographics
NPI:1063404093
Name:MOSKOFF, LANE (MD)
Entity type:Individual
Prefix:DR
First Name:LANE
Middle Name:
Last Name:MOSKOFF
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 1:670 LAWN AVE
Mailing Address - Street 2:SU 4
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1571
Mailing Address - Country:US
Mailing Address - Phone:215-257-0414
Mailing Address - Fax:215-257-1740
Practice Address - Street 1:670 LAWN AVE
Practice Address - Street 2:SU 4
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1571
Practice Address - Country:US
Practice Address - Phone:215-257-0414
Practice Address - Fax:215-257-1740
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061728L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017042630003Medicaid
100769OtherOTHER BS
0743293000OtherINDEPENDENCE BLUE CROSS
30022260OtherOTHER HMO
5043628OtherAETNA
PAG86379Medicare UPIN
100769OtherOTHER BS