Provider Demographics
NPI:1003177528
Name:MOORE, DOROTHY
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NEW JERSEY AVE NW
Mailing Address - Street 2:321
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1317
Mailing Address - Country:US
Mailing Address - Phone:202-408-2686
Mailing Address - Fax:
Practice Address - Street 1:5101 WISCONSIN AVE NW
Practice Address - Street 2:250
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4120
Practice Address - Country:US
Practice Address - Phone:202-832-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide