MEDICARE: SUSAN M MOYER P.A.

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	363A00000X	Physician Assistant	50001051	OH

General Provider Information

NPI Number	:	1922062868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M MOYER P.A.

Provider Business Mailing Address
First Line	:	8355 STIRRUP COURT
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060
Country	:	US
Telephone Number	:	440-975-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	36000 EUCLID AVE
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094
Country	:	US
Telephone Number	:	440-953-9600
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/08/2007

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