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General NPI Number Information
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NPI Number | 1346437472
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Entity Type | Individual
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Provider Name | BETHANNE LOUISE MOORE M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 5480 WISCONSIN AVE SUITE 224
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City | CHEVY CHASE
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State | MD
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Zip | 20815-3530
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Country | US
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Telephone | 301-656-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 5480 WISCONSIN AVE SUITE 224
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City | CHEVY CHASE
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State | MD
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Zip | 20815-3530
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Country | US
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Telephone | 301-656-5565
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0042416
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License Number State | MD
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