Provider Demographics
NPI:1790075638
Name:MOZLEY, P. DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:P. DAVID
Middle Name:
Last Name:MOZLEY
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 1:1033 ANVIL DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1570
Mailing Address - Country:US
Mailing Address - Phone:215-353-8958
Mailing Address - Fax:
Practice Address - Street 1:1033 ANVIL DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-1570
Practice Address - Country:US
Practice Address - Phone:215-353-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055728A207U00000X
PAMD034084E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine