Provider Demographics
NPI:1588792048
Name:MICHAEL T MOSHER M.D A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL T MOSHER M.D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-8522
Mailing Address - Street 1:415 ROLLING OAKS DR STE 280
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1049
Mailing Address - Country:US
Mailing Address - Phone:805-496-8522
Mailing Address - Fax:805-496-0469
Practice Address - Street 1:415 ROLLING OAKS DR STE 280
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1049
Practice Address - Country:US
Practice Address - Phone:805-496-8522
Practice Address - Fax:805-496-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17195Medicare ID - Type UnspecifiedGROUP ID