MEDICARE: MS. DIANA N MOLDOVEANU M.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	207R00000X	Internal Medicine Physician	049067	GA
2	207R00000X	Internal Medicine Physician	ME120636	FL
3	208M00000X	Hospitalist Physician	ME120636	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00147233	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39020409859	OTHER	GA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396716528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA N MOLDOVEANU M.D.

Provider Business Mailing Address
First Line	:	1741 DAVID WALKER DR
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5745
Country	:	US
Telephone Number	:	352-742-8836
Fax Number	:	352-742-8829

Provider Business Practice Location Address
First Line	:	1741 DAVID WALKER DR
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5745
Country	:	US
Telephone Number	:	352-742-8836
Fax Number	:	352-742-8829

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/21/2022

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