Basic Information
Provider Information | |||||||||
NPI: | 1710925482 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MOYER | ||||||||
FirstName: | CARRIE | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TRIMMER | ||||||||
OtherFirstName: | CARRIE | ||||||||
OtherMiddleName: | S | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3421 CONCORD RD | ||||||||
Address2: |   | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174029001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178512441 | ||||||||
FaxNumber: | 7172603322 | ||||||||
Practice Location | |||||||||
Address1: | 30 MONUMENT RD | ||||||||
Address2: | SUITE 1100 | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174035024 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178512441 | ||||||||
FaxNumber: | 7172603322 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/03/2006 | ||||||||
LastUpdateDate: | 09/26/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/26/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA0027451 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 03273401 | 01 | PA | CAPITAL BLUECROSS | OTHER | 2504226 | 01 | PA | HIGHMARK BCBS | OTHER | P00265675 | 01 | PA | RAILROAD MEDICARE | OTHER |