Provider Demographics
NPI:1558447516
Name:MOSCUCCI, MAURO (MD, MBA, MPH)
Entity type:Individual
Prefix:
First Name:MAURO
Middle Name:
Last Name:MOSCUCCI
Suffix:
Gender:M
Credentials:MD, MBA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 FELL ST UNIT 418
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3546
Mailing Address - Country:US
Mailing Address - Phone:734-276-6663
Mailing Address - Fax:
Practice Address - Street 1:960 FELL ST UNIT 418
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3546
Practice Address - Country:US
Practice Address - Phone:734-276-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0078436207R00000X, 207RC0000X
MI4301064397207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3123238Medicaid
MI3123238Medicaid