Provider Demographics
NPI:1033151964
Name:MOORE, ROBERT CLEAVELAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLEAVELAND
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:SUITE222
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1001
Mailing Address - Country:US
Mailing Address - Phone:410-266-5084
Mailing Address - Fax:410-266-7289
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:SUITE222
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1001
Practice Address - Country:US
Practice Address - Phone:410-266-5084
Practice Address - Fax:410-266-7289
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25178208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD66500Medicare UPIN
6308Medicare ID - Type Unspecified