Provider Demographics
NPI:1154378719
Name:MOSCHELLA, CHRISTOPHER CHARLES (PAC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:MOSCHELLA
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 N. CHARLES STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-849-4270
Mailing Address - Fax:443-849-4280
Practice Address - Street 1:6535 N. CHARLES STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-849-4270
Practice Address - Fax:443-849-4280
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006031363A00000X
FLPA9101031363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant