Healthcare Provider Details

I. General information

NPI: 1881075372
Provider Name (Legal Business Name): MICHAEL MORIARTY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 WELSH RD
HORSHAM PA
19044-2242
US

IV. Provider business mailing address

PO BOX 788735
PHILADELPHIA PA
19178-8735
US

V. Phone/Fax

Practice location:
  • Phone: 215-379-3200
  • Fax: 215-379-3826
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS019260
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number63504
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63504
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: