Provider Demographics
NPI:1326027665
Name:MOYER, MICHELLE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEE
Last Name:MOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:FONTAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1910 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6053
Mailing Address - Country:US
Mailing Address - Phone:845-454-0120
Mailing Address - Fax:845-454-8454
Practice Address - Street 1:1910 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-454-0120
Practice Address - Fax:845-454-8454
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275678207XS0106X
MDD0065615207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04155102Medicaid