Provider Demographics
NPI:1124095906
Name:MOSES, GEORGE T (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:MOSES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622
Mailing Address - Country:US
Mailing Address - Phone:330-343-6631
Mailing Address - Fax:330-343-8188
Practice Address - Street 1:201 NE PARK PLAZA DR STE 145
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5873
Practice Address - Country:US
Practice Address - Phone:360-729-8383
Practice Address - Fax:360-729-3534
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15.632084P0800X
OH34007515M2084P0800X
WV15632084P0800X
WAOP615722252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHY544999OtherHEALTH PLAN
OH000000222218OtherANTHEM
OH2205947Medicaid
OH300197600OtherUS DEPT OF LABOR
OH292576000OtherMAGELLAN BEHAVIORAL
OH260049831OtherRAILROAD MEDICARE
OH311814468027OtherCARESOURCE
OHH30900Medicare UPIN
OH260049831OtherRAILROAD MEDICARE
OH2205947Medicaid