Healthcare Provider Details

I. General information

NPI: 1003804915
Provider Name (Legal Business Name): DARILYN MOYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 N BROAD ST
PHILADELPHIA PA
19140-5185
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-1800
  • Fax: 215-707-3644
Mailing address:
  • Phone: 215-707-1800
  • Fax: 215-707-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD037007E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD037007E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: