MEDICARE: DR. MARY PATRICIA MOORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2007-01142	NC

General Provider Information

NPI Number	:	1861672347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY PATRICIA MOORE M.D.

Provider Business Mailing Address
First Line	:	280 BROAD ST STE E
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-2948
Country	:	US
Telephone Number	:	336-277-6050
Fax Number	:	336-992-3141

Provider Business Practice Location Address
First Line	:	280 BROAD ST STE E
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-2948
Country	:	US
Telephone Number	:	336-277-6050
Fax Number	:	336-992-3141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	10/25/2020

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