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General NPI Number Information
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NPI Number | 1801504477
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Entity Type | Individual
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Provider Name | LAUREN MARIE MOODY PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/11/2022
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 1203 LANGHORNE NEWTOWN RD STE 335
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City | LANGHORNE
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State | PA
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Zip | 19047-1236
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Country | US
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Telephone | 215-741-2707
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34990
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City | BELFAST
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State | ME
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Zip | 04915-0627
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Country | US
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Telephone | 610-359-5672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00659800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA064842
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License Number State | PA
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