Healthcare Provider Details

I. General information

NPI: 1871092551
Provider Name (Legal Business Name): ERNEST MOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 TOLEDO RD
HYATTSVILLE MD
20782-2064
US

IV. Provider business mailing address

17818 AUBURN VILLAGE DR
SANDY SPRING MD
20860-1030
US

V. Phone/Fax

Practice location:
  • Phone: 301-458-4385
  • Fax:
Mailing address:
  • Phone: 301-549-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0043995
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: