Individual
MARIO MOYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
647 MALIN RD, NEWTOWN SQUARE, PA 19073-2621
(610) 908-2995
Mailing address
1400 NORTHGATE LN, MCALLEN, TX 78504-9558
(610) 908-2995
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD048581L
PA
2085R0204X
Vascular & Interventional Radiology Physician
25MA06785000
NJ
2085R0204X
Vascular & Interventional Radiology Physician
MD00048471
WA
2085R0204X
Vascular & Interventional Radiology Physician
MD048581L
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
P3778
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6895808
—
NJ
01
—
P00391336
RR MEDICARE
NJ
Enumeration date
03/09/2006
Last updated
09/02/2022
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