Healthcare Provider Details

I. General information

NPI: 1124440359
Provider Name (Legal Business Name): CYNTHIA J MOORMAN MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 THOMAS JOHNSON DR SUITE K
FREDERICK MD
21702-4893
US

IV. Provider business mailing address

77 THOMAS JOHNSON DR SUITE K
FREDERICK MD
21702-4893
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-4868
  • Fax: 301-662-0050
Mailing address:
  • Phone: 301-662-4868
  • Fax: 301-662-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberD0054731
License Number StateMD

VIII. Authorized Official

Name: MRS. CHRISTINE M MORNINGSTAR
Title or Position: PRACTICE ADMINISTRATOR
Credential: RN
Phone: 301-662-5277