Provider Demographics
NPI:1790861102
Name:MOLDOVAN, STANTON I (MD)
Entity Type:Individual
Prefix:
First Name:STANTON
Middle Name:I
Last Name:MOLDOVAN
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 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2415
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2767
Mailing Address - Country:US
Mailing Address - Phone:713-790-0911
Mailing Address - Fax:713-790-0922
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2415
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2767
Practice Address - Country:US
Practice Address - Phone:713-790-0911
Practice Address - Fax:713-790-0922
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE30682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24959Medicare UPIN
TX00AA17Medicare ID - Type Unspecified