=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124440359
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYNTHIA J MOORMAN MD,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2014
-----------------------------------------------------
Last Update Date | 03/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 THOMAS JOHNSON DR SUITE K
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21702-4893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-662-4868
-----------------------------------------------------
Fax | 301-662-0050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 THOMAS JOHNSON DR SUITE K
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21702-4893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-662-4868
-----------------------------------------------------
Fax | 301-662-0050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | MRS. CHRISTINE M MORNINGSTAR
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 301-662-5277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | D0054731
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------