Provider Demographics
NPI:1326063330
Name:MOESSNER, MARY JANE (PA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:MOESSNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:60 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2220
Practice Address - Country:US
Practice Address - Phone:215-663-6600
Practice Address - Fax:215-663-6265
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA000317L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106223FLAMedicare PIN