Provider Demographics
NPI:1699789198
Name:MOIEN, ALLEN J (DPM)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:J
Last Name:MOIEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8149 MANDAN TER
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2643
Mailing Address - Country:US
Mailing Address - Phone:301-441-8632
Mailing Address - Fax:
Practice Address - Street 1:8149 MANDAN TER
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2643
Practice Address - Country:US
Practice Address - Phone:301-441-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00417213E00000X
VA0103000366213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPRJ67L2OtherSUBMITTER I.D. WITH HIGHMARK
DCPRJ67L2OtherSUBMITTER I.D. WITH HIGHMARK