Provider Demographics
NPI:1316642432
Name:MOODY, DAVID JOSEPH
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:MOODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 WISCONSIN AVE NW APT 508
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4109
Mailing Address - Country:US
Mailing Address - Phone:202-528-3812
Mailing Address - Fax:612-329-0215
Practice Address - Street 1:2201 WISCONSIN AVE NW APT 508
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4109
Practice Address - Country:US
Practice Address - Phone:202-528-3812
Practice Address - Fax:612-329-0215
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management