Provider Demographics
NPI:1982691309
Name:MOFFAT, JAMES B (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:MOFFAT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN235347L163W00000X
PA030859367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019709850003Medicaid
PA50010794OtherCAPITAL ADVANTAGE
PA0531587OtherKHP CENTRAL
PA1544275OtherGATEWAY
PA0531587OtherHIGHMARK
PA11803039OtherCAQH
PA76108OtherGEISINGER
PA0531587OtherFIRST PRIORITY
PA0734755000OtherINDEP. BLUE CROSS
PA7790267OtherAETNA
PA0531587OtherFIRST PRIORITY
PAP00001327Medicare PIN
PA531587QCYMedicare PIN