Provider Demographics
NPI:1124067350
Name:MOSCOW, DANIEL MARK (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARK
Last Name:MOSCOW
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 1:1244 FORT WASHINGTON AVE STE E2
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1743
Mailing Address - Country:US
Mailing Address - Phone:215-646-1686
Mailing Address - Fax:215-628-4956
Practice Address - Street 1:1244 FORT WASHINGTON AVE STE E2
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1743
Practice Address - Country:US
Practice Address - Phone:215-646-1686
Practice Address - Fax:215-628-4956
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060189L207Q00000X
PAMD060189-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001669066Medicaid
PA003669N6PMedicare ID - Type Unspecified
PA003669Medicare PIN
PA001669066Medicaid
PA1669066Medicaid