Provider Demographics
NPI:1962525642
Name:MOFFETT, ALLISON CHAPPELEAR (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:CHAPPELEAR
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:CHAPPELEAR
Other - Last Name:STANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19000 ALPENGLOW LN
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-2702
Mailing Address - Country:US
Mailing Address - Phone:240-476-5632
Mailing Address - Fax:301-774-8936
Practice Address - Street 1:18101 PRINCE PHILIP DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1514
Practice Address - Country:US
Practice Address - Phone:301-774-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002487363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical