Healthcare Provider Details

I. General information

NPI: 1417953167
Provider Name (Legal Business Name): PHILIP MOLDOFSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 W LANCASTER AVE
BRYN MAWR PA
19010-3336
US

IV. Provider business mailing address

101 GREENWOOD AVE SUITE 150
JENKINTOWN PA
19046-2627
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-8600
  • Fax: 610-527-1234
Mailing address:
  • Phone: 215-379-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD019745E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: