Healthcare Provider Details

I. General information

NPI: 1225016199
Provider Name (Legal Business Name): JUDITH STEVENS MORIARTY CNM, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26005 RIDGE RD #200
DAMASCUS MD
20872-1892
US

IV. Provider business mailing address

26005 RIDGE RD #200
DAMASCUS MD
20872-1892
US

V. Phone/Fax

Practice location:
  • Phone: 301-414-2300
  • Fax:
Mailing address:
  • Phone: 301-414-2300
  • Fax: 301-414-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR142560
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR142560
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: