Provider Demographics
NPI:1023774288
Name:MOYER, TABITHA
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:MOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 BRAY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-7914
Mailing Address - Country:US
Mailing Address - Phone:240-321-5391
Mailing Address - Fax:240-321-5391
Practice Address - Street 1:438 BRAY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-7914
Practice Address - Country:US
Practice Address - Phone:240-321-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker