Provider Demographics
NPI:1871586925
Name:MOFFITT, VINCENT JOHN (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOHN
Last Name:MOFFITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:STE 3170
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:610-374-4491
Mailing Address - Fax:610-478-1170
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:STE 3170
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-374-4491
Practice Address - Fax:610-478-1170
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD015506E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
090527Medicare ID - Type Unspecified
B35454Medicare UPIN