Healthcare Provider Details

I. General information

NPI: 1831481761
Provider Name (Legal Business Name): MARTONA MOODY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MARVEL RD
MILFORD DE
19963-1740
US

IV. Provider business mailing address

515 FAIRMOUNT AVE FL 8
TOWSON MD
21286-5466
US

V. Phone/Fax

Practice location:
  • Phone: 302-422-3303
  • Fax:
Mailing address:
  • Phone: 410-726-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0010371
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0040096
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: