Provider Demographics
NPI:1902559446
Name:MOYLAN, MARYANN (RD)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:MOYLAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 TRUTH PL
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-8708
Mailing Address - Country:US
Mailing Address - Phone:610-391-9305
Mailing Address - Fax:
Practice Address - Street 1:755 MEMORIAL PKWY STE 302A
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2771
Practice Address - Country:US
Practice Address - Phone:908-847-2050
Practice Address - Fax:866-449-5832
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered