Healthcare Provider Details

I. General information

NPI: 1114500857
Provider Name (Legal Business Name): DANIEL BEN-MOYAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S PACA ST FL 8
BALTIMORE MD
21201-1644
US

IV. Provider business mailing address

110 S PACA ST FL 8
BALTIMORE MD
21201-1644
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6003
  • Fax:
Mailing address:
  • Phone: 410-328-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0100454
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: