Provider Demographics
NPI:1548268238
Name:MOFF, JOANNE M (PA-C)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:MOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:STE 1480
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-3220
Mailing Address - Fax:937-208-3633
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE 1480
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-3220
Practice Address - Fax:937-208-3633
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50001540363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067859Medicaid
OHH117220Medicare PIN