Healthcare Provider Details

I. General information

NPI: 1316620891
Provider Name (Legal Business Name): DANHUE LIVINGSTON MOODIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-3120
  • Fax: 667-234-3525
Mailing address:
  • Phone: 667-234-3120
  • Fax: 667-234-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.156340
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.156340
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: