Provider Demographics
NPI:1861727257
Name:MOSHER, CONSTANCE ALEETA (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:ALEETA
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CONSTANCE
Other - Middle Name:ALEETA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2973 WOLFBIRCH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4405
Mailing Address - Country:US
Mailing Address - Phone:614-570-5205
Mailing Address - Fax:
Practice Address - Street 1:2973 WOLFBIRCH DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4405
Practice Address - Country:US
Practice Address - Phone:614-570-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH69052207Q00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH2479787Medicaid
OHH2479787Medicaid