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General NPI Number Information
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NPI Number | 1639363559
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Entity Type | Organization
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Legal Business Name | MARYANN D. MOORE, MDPA
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 300 DORCHESTER AVE
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City | CAMBRIDGE
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State | MD
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Zip | 21613-2420
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Country | US
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Telephone | 410-228-2603
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Fax | 410-901-6080
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Provider Business Mailing Address
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Address Line | 300 DORCHESTER AVE
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City | CAMBRIDGE
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State | MD
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Zip | 21613-2420
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Country | US
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Telephone | 410-228-2603
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Fax | 410-901-6080
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY ANN MOORE
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Credential | M.D.
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Telephone | 410-228-2603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C0000549
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0031766
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License Number State | MD
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