Healthcare Provider Details

I. General information

NPI: 1194730580
Provider Name (Legal Business Name): YORAM MOYAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SOM CENTER RD STE 230
MAYFIELD VILLAGE OH
44143-2362
US

IV. Provider business mailing address

730 SOM CENTER RD STE 230
MAYFIELD OH
44143-2362
US

V. Phone/Fax

Practice location:
  • Phone: 440-461-6477
  • Fax: 440-461-1017
Mailing address:
  • Phone: 440-461-6477
  • Fax: 440-461-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35057982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: