Basic Information
| Provider Information | |||||||||
| NPI: | 1932660362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOON | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDSTAR WASHINGTON HOSPITAL CENTER - SICU | ||||||||
| Address2: | 110 IRVING ST. NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028777000 | ||||||||
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| Practice Location | |||||||||
| Address1: | MEDSTAR WASHINGTON HOSPITAL CENTER - SICU | ||||||||
| Address2: | 110 IRVING STREET NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028777000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA031640 | DC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.