Healthcare Provider Details

I. General information

NPI: 1679527485
Provider Name (Legal Business Name): MARK DAVID MOGLOWSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LONGWOOD DR SW
HUNTSVILLE AL
35801-4522
US

IV. Provider business mailing address

PO BOX 2324
BIRMINGHAM AL
35201-2324
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-6488
  • Fax: 256-533-6495
Mailing address:
  • Phone: 256-533-7064
  • Fax: 256-704-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number032157
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME99163
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number31469
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD.31660
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: