MEDICARE: STANTON I. MOLDOVAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	E3068	TX

General Provider Information

NPI Number	:	1790861102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANTON I. MOLDOVAN M.D.

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 2415
City	:	HOUSTON
State	:	TX
Zip	:	77030-2767
Country	:	US
Telephone Number	:	713-790-0911
Fax Number	:	713-790-0922

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 2415
City	:	HOUSTON
State	:	TX
Zip	:	77030-2767
Country	:	US
Telephone Number	:	713-790-0911
Fax Number	:	713-790-0922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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