Provider Demographics
NPI:1447245899
Name:MOYLAN, DAVID J III (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:MOYLAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:17959-0441
Mailing Address - Country:US
Mailing Address - Phone:570-277-6218
Mailing Address - Fax:570-277-6398
Practice Address - Street 1:15 ALLIANCE ST
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:17959-1101
Practice Address - Country:US
Practice Address - Phone:570-277-6218
Practice Address - Fax:570-277-6398
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020915E2085R0001X
PAMD 020915 E2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000863185Medicaid
PA004139Medicare ID - Type Unspecified
PA000863185Medicaid
NYA400000304Medicare PIN
PA004139JT3Medicare PIN