Provider Demographics
NPI:1063471050
Name:MOSHER, JESSICA SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SUZANNE
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 WELLESLEY RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2125
Mailing Address - Country:US
Mailing Address - Phone:617-710-6585
Mailing Address - Fax:617-710-6585
Practice Address - Street 1:2000 WASHINGTON ST STE 548
Practice Address - Street 2:
Practice Address - City:NEWTON LOWER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02462-1624
Practice Address - Country:US
Practice Address - Phone:617-710-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217725207ND0900X, 207NI0002X, 207NS0135X, 207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2139677Medicaid
MAA3634703Medicare PIN