Healthcare Provider Details

I. General information

NPI: 1699100263
Provider Name (Legal Business Name): ALICE MCCARTY MOORE APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S UNION AVE
HAVRE DE GRACE MD
21078-3610
US

IV. Provider business mailing address

805 S UNION AVE
HAVRE DE GRACE MD
21078-3610
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-5843
  • Fax: 410-939-3538
Mailing address:
  • Phone: 410-939-5843
  • Fax: 410-939-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR227531
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00436000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: