MEDICARE: DR. ALIA MARIE MOINUDDIN 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	2084P0800X	Psychiatry Physician	35.140745	OH
2	2084P0800X	Psychiatry Physician	MD063634L	PA

General Provider Information

NPI Number	:	1871785329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALIA MARIE MOINUDDIN M.D.

Provider Business Mailing Address
First Line	:	29055 CLEMENS RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29055 CLEMENS RD STE A
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1135
Country	:	US
Telephone Number	:	216-450-1613
Fax Number	:	216-450-1614

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

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	02/09/2021

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