=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669532347
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAVAKA K MOORE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7610 PENNSYLVANIA AVE STE 305
-----------------------------------------------------
City | FORESTVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20747-4764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-669-1870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7610 PENNSYLVANIA AVE SUITE 305
-----------------------------------------------------
City | FORESTVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-669-1870
-----------------------------------------------------
Fax | 301-669-1873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | D0065087
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------