Provider Demographics
NPI:1144350125
Name:MOSLEY, STEVEN R (D P M)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:D P M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 CHARLESTOWN RD
Mailing Address - Street 2:STE 6
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9497
Mailing Address - Country:US
Mailing Address - Phone:812-944-5600
Mailing Address - Fax:812-944-4674
Practice Address - Street 1:5120 CHARLESTOWN RD
Practice Address - Street 2:STE 6
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9497
Practice Address - Country:US
Practice Address - Phone:812-944-5600
Practice Address - Fax:812-944-4674
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000879A213ES0131X
MA2094213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200265250AMedicaid
MAY78041Medicare ID - Type Unspecified
IN140080Medicare ID - Type Unspecified
IN200265250AMedicaid