MEDICARE: MEAGHAN MOXLEY

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	D87761	MD
2	208000000X	Pediatrics Physician	D87761	MD
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	D87761	MD

General Provider Information

NPI Number	:	1669869632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGHAN MOXLEY

Provider Business Mailing Address
First Line	:	1250 E MARSHALL STREET
Second Line	:	BOX 980163
City	:	RICHMOND
State	:	VA
Zip	:	23298
Country	:	US
Telephone Number	:	804-828-9357
Fax Number	:	804-828-5466

Provider Business Practice Location Address
First Line	:	650 MCHENRY RD STE 3300
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2682
Country	:	US
Telephone Number	:	443-843-6100
Fax Number	:

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

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	12/30/2021

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Directions to “ MEAGHAN MOXLEY ” Practice Location

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