Provider Demographics
NPI:1780610931
Name:MOYER, ALYSSA LARIN (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LARIN
Last Name:MOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LARIN
Other - Last Name:MENGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069112L207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2161248OtherMAMSI-WMG
PA30131967OtherAMERIHEALTH MERCY - WMG
PA160569OtherUNISON-WMG
PA01684402OtherCAPITAL BLUE CROSS-WMG
PA7539483OtherAETNA
PA001797324Medicaid
PA39998OtherJOHNS HOPKINS
PA41096OtherGEISINGER
MD608638OtherCAREFIRST MD BCBS
MD034069300Medicaid
PA1142298OtherAH MERCY-WMG COLONIAL AVE
PAP002896OtherGATEWAY-WMG
PA1582036OtherGATEWAY
PA172259OtherHIGHMARK BLUE SHIELD
PA20090444OtherAMERIHEALTH MERCY-WMG
PA2161248OtherMAMSI-WMG
PA037603EZ3Medicare PIN
PA39998OtherJOHNS HOPKINS
PA1582036OtherGATEWAY