Provider Demographics
NPI:1396798740
Name:MOYER, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MOYER
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 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:215-443-3850
Mailing Address - Fax:215-443-3963
Practice Address - Street 1:10000 ANNS CHOICE WAY
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3527
Practice Address - Country:US
Practice Address - Phone:215-443-3850
Practice Address - Fax:215-443-3963
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026284E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
611455212002OtherTRICARE NORTH
0054161000OtherKEYSTONE/PERSONAL CHOICE
000095186OtherHIGHMARK BCBS
04-78954OtherEVERCARE
PA095186Medicare ID - Type Unspecified
095186R3WMedicare PIN
04-78954OtherEVERCARE
P00760934Medicare PIN