Healthcare Provider Details

I. General information

NPI: 1528218716
Provider Name (Legal Business Name): ANDREA ROLANDO FRYE MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA R MOORE MD

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 KOLBE RD
LORAIN OH
44053-1611
US

IV. Provider business mailing address

3700 KOLBE RD
LORAIN OH
44053-1611
US

V. Phone/Fax

Practice location:
  • Phone: 440-988-1009
  • Fax: 440-988-1227
Mailing address:
  • Phone: 440-988-1009
  • Fax: 440-988-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number35.127940
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: