Provider Demographics
NPI:1255755328
Name:MARIO MOYA MD PA
Entity type:Organization
Organization Name:MARIO MOYA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-908-2995
Mailing Address - Street 1:647 MALIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2621
Mailing Address - Country:US
Mailing Address - Phone:610-908-2995
Mailing Address - Fax:215-240-1677
Practice Address - Street 1:647 MALIN RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2621
Practice Address - Country:US
Practice Address - Phone:610-908-2995
Practice Address - Fax:215-240-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty