Provider Demographics
NPI:1699902643
Name:MOLDOVAN, THAIS (MD)
Entity type:Individual
Prefix:DR
First Name:THAIS
Middle Name:
Last Name:MOLDOVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THAIS
Other - Middle Name:BOTELHO DE
Other - Last Name:MENDONCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3551 RHOADS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3629
Mailing Address - Country:US
Mailing Address - Phone:484-428-3336
Mailing Address - Fax:484-422-8451
Practice Address - Street 1:3551 RHOADS AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3629
Practice Address - Country:US
Practice Address - Phone:484-428-3336
Practice Address - Fax:484-422-8451
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT194296207R00000X
PAMD452238207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine