Provider Demographics
NPI:1033442991
Name:MOFFATT, DANA CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:CHARLES
Last Name:MOFFATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 N WEST ST
Mailing Address - Street 2:APT 284
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4207
Mailing Address - Country:US
Mailing Address - Phone:131-769-8919
Mailing Address - Fax:
Practice Address - Street 1:359 N WEST ST
Practice Address - Street 2:APT 284
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4207
Practice Address - Country:US
Practice Address - Phone:131-769-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11014752A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology