Healthcare Provider Details

I. General information

NPI: 1699902643
Provider Name (Legal Business Name): THAIS MOLDOVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THAIS BOTELHO DE MENDONCA M.D.

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 E BALTIMORE PIKE
MEDIA PA
19063-5197
US

IV. Provider business mailing address

1022 E BALTIMORE PIKE
MEDIA PA
19063-5197
US

V. Phone/Fax

Practice location:
  • Phone: 484-428-3336
  • Fax: 484-301-0607
Mailing address:
  • Phone: 484-428-3336
  • Fax: 484-301-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT194296
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD452238
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: