Provider Demographics
NPI:1992759799
Name:MOSEMANN, CHRISTIAN W
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:W
Last Name:MOSEMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 YODER LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6558
Mailing Address - Country:US
Mailing Address - Phone:757-877-5930
Mailing Address - Fax:
Practice Address - Street 1:12420 WARWICK BLVD
Practice Address - Street 2:BUILDING 7, SUITE C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3001
Practice Address - Country:US
Practice Address - Phone:757-595-3900
Practice Address - Fax:757-595-0649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040001191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA253753OtherANTHEM/TRIGON
VA8921636Medicaid
VA253753OtherBCBS
VA132093OtherMHN
VA089989OtherSENTARA