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General NPI Number Information
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NPI Number | 1073956918
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Entity Type | Individual
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Provider Name | MAUREEN DALY MOORE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 1107 ROBIN RD
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City | GLADWYNE
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State | PA
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Zip | 19035-1007
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Country | US
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Telephone | 610-527-6186
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST # 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 856-356-4924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA11070100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 303373
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License Number State | NY
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