Healthcare Provider Details

I. General information

NPI: 1194908665
Provider Name (Legal Business Name): MARGARET ANN MOXNESS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E CENTRAL BLVD #201
ORLANDO FL
32801-1923
US

IV. Provider business mailing address

424 E CENTRAL BLVD #201
ORLANDO FL
32801-1923
US

V. Phone/Fax

Practice location:
  • Phone: 513-312-0635
  • Fax:
Mailing address:
  • Phone: 513-312-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35.081689
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 107989
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 107989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: