Provider Demographics
NPI:1497343040
Name:MOAG, ALBERT E
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:E
Last Name:MOAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 36TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2739
Mailing Address - Country:US
Mailing Address - Phone:330-209-4599
Mailing Address - Fax:
Practice Address - Street 1:1824 36TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2739
Practice Address - Country:US
Practice Address - Phone:330-209-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care