Provider Demographics
NPI:1114002540
Name:MOYER, LAWSON A III (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWSON
Middle Name:A
Last Name:MOYER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:955 LEXINGTON AVE
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5128
Mailing Address - Country:US
Mailing Address - Phone:212-288-4638
Mailing Address - Fax:212-288-4668
Practice Address - Street 1:955 LEXINGTON AVE
Practice Address - Street 2:SUITE #1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5128
Practice Address - Country:US
Practice Address - Phone:212-288-4638
Practice Address - Fax:212-288-4668
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY121668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD47316Medicare UPIN