Provider Demographics
NPI:1245524560
Name:MOSCHELLA, CARLA JAN (PA-C)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JAN
Last Name:MOSCHELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-2919
Mailing Address - Country:US
Mailing Address - Phone:781-233-7651
Mailing Address - Fax:
Practice Address - Street 1:14 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-2919
Practice Address - Country:US
Practice Address - Phone:781-233-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001249363AM0700X
MA867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical