Healthcare Provider Details

I. General information

NPI: 1841599370
Provider Name (Legal Business Name): JULIANNE MOY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27100 CHARDON RD
RICHMOND HEIGHTS OH
44143-1116
US

IV. Provider business mailing address

6721 OHARRA RD
GALLOWAY OH
43119-9660
US

V. Phone/Fax

Practice location:
  • Phone: 440-585-6500
  • Fax:
Mailing address:
  • Phone: 740-818-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: