Basic Information
Provider Information
NPI: 1447436084
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOYER
FirstName: RACHEL
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 783311
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191783311
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1210 S CEDAR CREST BLVD
Address2: SUITE 1100
City: ALLENTOWN
State: PA
PostalCode: 181036229
CountryCode: US
TelephoneNumber: 6104026555
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/14/2008
LastUpdateDate: 12/18/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XMA053287PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


Home