Provider Demographics
NPI:1962642298
Name:MOYLAN, JACQUELINE DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:DENISE
Last Name:MOYLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ALLIANCE ST
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:17959-1101
Mailing Address - Country:US
Mailing Address - Phone:570-127-7621
Mailing Address - Fax:570-277-6398
Practice Address - Street 1:15 ALLIANCE ST
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:17959-1101
Practice Address - Country:US
Practice Address - Phone:570-127-7621
Practice Address - Fax:570-277-6398
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 015280 E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease