1306002423 NPI number — TERESA MOON M.D.

Table of content: TERESA MOON M.D. (NPI 1306002423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306002423 NPI number — TERESA MOON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOON
Provider First Name:
TERESA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CZAPLICKI
Provider Other First Name:
TERESA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306002423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PERKINS SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44308-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-676-1020
Provider Business Mailing Address Fax Number:
330-678-4092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 WHITE POND DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44320-1193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-865-1252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  35.096478 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)