Healthcare Provider Details

I. General information

NPI: 1689762940
Provider Name (Legal Business Name): NANCY CARROLL MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 OHIO DR
GROVE CITY OH
43123-4835
US

IV. Provider business mailing address

1955 OHIO DR
GROVE CITY OH
43123-4835
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5808
  • Fax: 614-257-5801
Mailing address:
  • Phone: 614-257-5808
  • Fax: 614-257-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35069260
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: