Provider Demographics
NPI:1851146435
Name:MOFFET, SAMUEL ALEXANDER
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ALEXANDER
Last Name:MOFFET
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 RESERVOIR RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2126
Mailing Address - Country:US
Mailing Address - Phone:202-444-4922
Mailing Address - Fax:202-444-6292
Practice Address - Street 1:3900 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2126
Practice Address - Country:US
Practice Address - Phone:202-444-4922
Practice Address - Fax:202-444-6292
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program