Provider Demographics
NPI:1992922124
Name:DONNALYN MOELLER, DPM,INC
Entity type:Organization
Organization Name:DONNALYN MOELLER, DPM,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:614-272-8854
Mailing Address - Street 1:3131 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1306
Mailing Address - Country:US
Mailing Address - Phone:614-272-8854
Mailing Address - Fax:614-272-9200
Practice Address - Street 1:3131 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1306
Practice Address - Country:US
Practice Address - Phone:614-272-8854
Practice Address - Fax:614-272-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002995213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2791573Medicaid
OHDN0823OtherRAILROAD MEDICARE
OHDN0823OtherRAILROAD MEDICARE
OH6102940001Medicare NSC