Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0101271565 | VA |
NPI | 1063893717 |
---|---|
Provider Name | Dr. Matthew J Moynihan |
First Address | Baltimore, MD 21297-3174 |
Second Address | Fairfax, VA 22031-4867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 01/09/2021 |