Basic Information
Provider Information
NPI: 1104249135
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOVVA
FirstName: ASHOK
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 FAIRFIELD DR
Address2:  
City: SENECA
State: PA
PostalCode: 163462130
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 100 FAIRFIELD DR
Address2:  
City: SENECA
State: PA
PostalCode: 163462130
CountryCode: US
TelephoneNumber: 8146767863
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/27/2014
LastUpdateDate: 03/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD468027PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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