Healthcare Provider Details

I. General information

NPI: 1457315988
Provider Name (Legal Business Name): JOHN M MOVASSAGHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W CENTRE ST
ASHLAND PA
17921-1343
US

IV. Provider business mailing address

124 W CENTRE ST
ASHLAND PA
17921-1343
US

V. Phone/Fax

Practice location:
  • Phone: 717-808-1667
  • Fax: 717-808-1667
Mailing address:
  • Phone: 717-808-1667
  • Fax: 717-808-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD426328
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: