Provider Demographics
NPI:1932185642
Name:MOSIELLO, RONALD L (DO)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:MOSIELLO
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 1:1232 PORTLAND RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ARUNDEL
Mailing Address - State:ME
Mailing Address - Zip Code:04046-8104
Mailing Address - Country:US
Mailing Address - Phone:207-464-9081
Mailing Address - Fax:866-870-3254
Practice Address - Street 1:1232 PORTLAND RD STE 5
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-8104
Practice Address - Country:US
Practice Address - Phone:207-464-9081
Practice Address - Fax:866-870-3254
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1650204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME284880099Medicaid
ME284880099Medicaid
MEH67030Medicare UPIN
MEMM952301Medicare PIN