Healthcare Provider Details

I. General information

NPI: 1669869632
Provider Name (Legal Business Name): MEAGHAN MOXLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MCHENRY RD STE 3300
ABERDEEN MD
21001-2682
US

IV. Provider business mailing address

1250 E MARSHALL STREET BOX 980163
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 443-843-6100
  • Fax:
Mailing address:
  • Phone: 804-828-9357
  • Fax: 804-828-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD87761
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD87761
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD87761
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: