Healthcare Provider Details

I. General information

NPI: 1063831014
Provider Name (Legal Business Name): DANIEL M MOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

IV. Provider business mailing address

1100 2ND PL SE APT 901
WASHINGTON DC
20003-2566
US

V. Phone/Fax

Practice location:
  • Phone: 703-287-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10650482-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: