Healthcare Provider Details

I. General information

NPI: 1063496735
Provider Name (Legal Business Name): LAURA B MOYLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MOYLAN JANNEY MD

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/18/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

640 S. STATE ST. MAIL CODE 3055
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax: 302-735-3246
Mailing address:
  • Phone: 302-674-4700
  • Fax: 302-735-3246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC10006733
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: