Healthcare Provider Details

I. General information

NPI: 1396906640
Provider Name (Legal Business Name): PHILIP W MOORE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 STATE ST
LEMOYNE PA
17043-1536
US

IV. Provider business mailing address

716 STATE ST
LEMOYNE PA
17043-1536
US

V. Phone/Fax

Practice location:
  • Phone: 717-547-5337
  • Fax:
Mailing address:
  • Phone: 717-547-5337
  • Fax: 717-609-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberOS015726
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS015726
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2143
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS015726
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberOS015726
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: