Healthcare Provider Details

I. General information

NPI: 1154768810
Provider Name (Legal Business Name): KAREN MOY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WISE AVE
DUNDALK MD
21222-4911
US

IV. Provider business mailing address

207 WISE AVE
DUNDALK MD
21222-4911
US

V. Phone/Fax

Practice location:
  • Phone: 410-284-1004
  • Fax: 410-284-2109
Mailing address:
  • Phone: 410-284-1004
  • Fax: 410-284-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005040
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: