MEDICARE: DR. CHARLES RICHARD MOELLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	007627	NY

General Provider Information

NPI Number	:	1053345777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES RICHARD MOELLER PH.D.

Provider Business Mailing Address
First Line	:	4301 MIDDLE SETTLEMENT RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-5317
Country	:	US
Telephone Number	:	315-724-2845
Fax Number	:	315-797-3667

Provider Business Practice Location Address
First Line	:	4301 MIDDLE SETTLEMENT RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-5317
Country	:	US
Telephone Number	:	315-724-2845
Fax Number	:	315-797-3667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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