MEDICARE: MERCY ROSSANA BAYOT MOORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	2013-02457	NC
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	J9965	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114927399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCY ROSSANA BAYOT MOORE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-1125
Fax Number	:	704-316-1143

Provider Business Practice Location Address
First Line	:	1918 RANDOLPH RD STE 220
Second Line	:	SUITE 220
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1109
Country	:	US
Telephone Number	:	704-316-1125
Fax Number	:	704-316-1143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/25/2020

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