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General NPI Number Information
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NPI Number | 1417945700
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Entity Type | Individual
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Provider Name | PAUL DEREK MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 815 CUMBERLAND ST SUITE 205
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City | LEBANON
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State | PA
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Zip | 17042-5266
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Country | US
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Telephone | 717-277-7400
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Fax | 717-277-7402
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Provider Business Mailing Address
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Address Line | 100 N CAMERON ST SUITE 401E
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City | HARRISBURG
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State | PA
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Zip | 17101-2424
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Country | US
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Telephone | 717-232-8535
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Fax | 717-232-8515
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 40759
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD444618
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License Number State | PA
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