Basic Information
| Provider Information | |||||||||
| NPI: | 1962525642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOFFETT | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | CHAPPELEAR | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A.-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STANFORD | ||||||||
| OtherFirstName: | ALLISON | ||||||||
| OtherMiddleName: | CHAPPELEAR | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19000 ALPENGLOW LN | ||||||||
| Address2: | |||||||||
| City: | BROOKEVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208332702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404765632 | ||||||||
| FaxNumber: | 3017748936 | ||||||||
| Practice Location | |||||||||
| Address1: | 18101 PRINCE PHILIP DR | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017748882 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | C0002487 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.