Provider Demographics
NPI:1912939216
Name:MOAK, ALAN S (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:MOAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:4 PHI
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-9189
Mailing Address - Fax:
Practice Address - Street 1:39TH AND MARKET ST
Practice Address - Street 2:4 PHI
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-9000
Practice Address - Fax:215-243-4611
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD035678E207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008434220002Medicaid
C58186Medicare UPIN
PA0008434220002Medicaid