Healthcare Provider Details

I. General information

NPI: 1124482294
Provider Name (Legal Business Name): MERIAH MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 DUBLIN RD
COLUMBUS OH
43215-1077
US

IV. Provider business mailing address

1211 DUBLIN RD
COLUMBUS OH
43215-1077
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-5200
  • Fax: 614-486-9665
Mailing address:
  • Phone: 614-486-5200
  • Fax: 614-486-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301504787
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35.145569
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: