Provider Demographics
NPI:1780689737
Name:MOYER, LENORE JOLENE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LENORE
Middle Name:JOLENE
Last Name:MOYER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:LENORE
Other - Middle Name:JOLENE
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:711 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4165
Mailing Address - Country:US
Mailing Address - Phone:814-943-3668
Mailing Address - Fax:814-942-7635
Practice Address - Street 1:711 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4165
Practice Address - Country:US
Practice Address - Phone:814-943-3668
Practice Address - Fax:814-942-7635
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004749L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001943530Medicaid
203328OtherUPMC
3142249/7154449PPOOtherAETNA
PA1530682OtherGATEWAY
79237-1327OtherGEISINGER
PA000000141108OtherMED-PLUS
99382OtherHEALTH AMERICA
MO1476655OtherBC/BS
79237-1327OtherGEISINGER
PA001943530Medicaid