Provider Demographics
NPI:1760460943
Name:MOYLAN, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:MOYLAN
Suffix:
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 1:1906 BRAEBURN DR.
Mailing Address - Street 2:VALLEY GASTROENTEROLOGY OF SOUTHWEST VA PC
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-776-6300
Mailing Address - Fax:540-776-6300
Practice Address - Street 1:1906 BRAEBURN DR
Practice Address - Street 2:VALLEY GASTROENTEROLOGY OF SW VA
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-776-6300
Practice Address - Fax:540-776-1103
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043742207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI006098088Medicaid
100009138OtherMEDICARE RAILROAD
260809OtherANTHEM
260809OtherANTHEM
100000168Medicare PIN