Provider Demographics
NPI:1811267008
Name:MOYER, DANIELLE E (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:E
Last Name:MOYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:E
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:23 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:PA
Mailing Address - Zip Code:17509
Mailing Address - Country:US
Mailing Address - Phone:717-786-0612
Mailing Address - Fax:717-806-0100
Practice Address - Street 1:23 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:PA
Practice Address - Zip Code:17509
Practice Address - Country:US
Practice Address - Phone:717-786-0612
Practice Address - Fax:717-806-0100
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine