Provider Demographics
NPI:1447372396
Name:MOSIERI, CHIZOBA N (MD)
Entity type:Individual
Prefix:DR
First Name:CHIZOBA
Middle Name:N
Last Name:MOSIERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MAGNOLIA XING
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5455
Mailing Address - Country:US
Mailing Address - Phone:706-495-0934
Mailing Address - Fax:318-828-4038
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY, LSUHSC
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:706-495-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068052207L00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208123401Medicaid
LA1807664Medicaid
SC30536OtherSTATE OF SOUTH CAROLINA, LABOR, LICENSING, REGULATION. BOARD OF MEDICAL EXAMINER
MDD0068052OtherMARYLAND BOARD OF PHYSICIANS
GA060540OtherSTATE OF GEORGIA, COMPOSITE STATE BOARD OF MEDICAL EXAMINERS
LA4M426F699Medicare PIN