Provider Demographics
NPI:1548215486
Name:MOYLAN, CHARLES VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:VINCENT
Last Name:MOYLAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4400 BROADWAY ST
Mailing Address - Street 2:#206
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3498
Mailing Address - Country:US
Mailing Address - Phone:816-561-8100
Mailing Address - Fax:816-561-8154
Practice Address - Street 1:4400 BROADWAY ST
Practice Address - Street 2:#206
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-561-8100
Practice Address - Fax:816-561-8154
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO36719208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics