Healthcare Provider Details

I. General information

NPI: 1114311974
Provider Name (Legal Business Name): THOMAS MOORE CPBMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MADISON AVE
PITTSBURGH PA
15212-4946
US

IV. Provider business mailing address

1020 MADISON AVE
PITTSBURGH PA
15212-4946
US

V. Phone/Fax

Practice location:
  • Phone: 855-606-5426
  • Fax: 412-321-0128
Mailing address:
  • Phone: 855-606-5426
  • Fax: 412-321-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: