Provider Demographics
NPI:1376794891
Name:HENRY MOYLE M.D., PHD, PC
Entity Type:Organization
Organization Name:HENRY MOYLE M.D., PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-876-4270
Mailing Address - Street 1:8501 ARLINGTON BLVD
Mailing Address - Street 2:330
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4617
Mailing Address - Country:US
Mailing Address - Phone:703-876-4270
Mailing Address - Fax:
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:330
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4617
Practice Address - Country:US
Practice Address - Phone:703-876-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243001207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H35130Medicare UPIN