Healthcare Provider Details

I. General information

NPI: 1538134606
Provider Name (Legal Business Name): SHERI N MOORE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 DAFFIN LN
DENTON MD
21629
US

IV. Provider business mailing address

PO BOX 660
DENTON MD
21629
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-2650
  • Fax: 410-479-1626
Mailing address:
  • Phone: 410-479-4306
  • Fax: 410-479-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH60809
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: