Healthcare Provider Details

I. General information

NPI: 1376625244
Provider Name (Legal Business Name): MATTHEW R MOORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR
BETHESDA MD
20892-1150
US

IV. Provider business mailing address

10 CENTER DR
BETHESDA MD
20892-1150
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-4000
  • Fax:
Mailing address:
  • Phone: 301-496-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0107081
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0107081
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: