Individual
ELIZABETH MOYNIHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
55 FRUIT ST, WHITE 1, BOSTON, MA 02114-2621
(617) 724-4100
(617) 726-7415
Mailing address
9 MARION ST, MEDFORD, MA 02155-6219
(860) 942-9878
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA8455
MA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
09/25/2020
Last updated
01/06/2022
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