Healthcare Provider Details

I. General information

NPI: 1508930611
Provider Name (Legal Business Name): NEIL LEE MOGGE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 SHARPE HOSPITAL RD
WESTON WV
26452-8550
US

IV. Provider business mailing address

936 SHARPE HOSPITAL RD
WESTON WV
26452-8550
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-1012
  • Fax: 304-269-6235
Mailing address:
  • Phone: 304-269-1012
  • Fax: 304-269-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number705
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: