Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 217725 | MA |
N | 207R00000X | Internist | 217725 | MA |
N | 111NI0900X | Internist | 217725 | MA |
NPI | 1063471050 |
---|---|
Provider Name | Dr. Jessica Suzanne Mosher |
First Address | Wellesley, MA 02481-4102 |
Second Address | Wellesley, MA 02481-4102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2139677 | (05) | MA |