Provider Demographics
NPI:1225147002
Name:MOFFA, MICHAEL A (MD)
Entity Type:Individual
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First Name:MICHAEL
Middle Name:A
Last Name:MOFFA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:GLACIER CREEK OFFICE PARK- BLDG II
Mailing Address - Street 2:6711 TOWPATH RD., SUITE 175
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9510
Mailing Address - Country:US
Mailing Address - Phone:315-458-2211
Mailing Address - Fax:315-452-9025
Practice Address - Street 1:GLACIER CREEK OFFICE PARK- BLDG II
Practice Address - Street 2:6711 TOWPATH RD., SUITE 175
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9510
Practice Address - Country:US
Practice Address - Phone:315-458-2211
Practice Address - Fax:315-452-9025
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-11-20
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Provider Licenses
StateLicense IDTaxonomies
NY200991208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01945160Medicaid
NY01945160Medicaid
H04854Medicare UPIN