Provider Demographics
NPI:1033435656
Name:MOORE, AMANDA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-0607
Mailing Address - Country:US
Mailing Address - Phone:302-424-4141
Mailing Address - Fax:302-422-6506
Practice Address - Street 1:8 N RACE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947
Practice Address - Country:US
Practice Address - Phone:302-424-4141
Practice Address - Fax:302-422-6506
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
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1033435656OtherDEVON HEALTH SERVICES
1033435656OtherPRIVATE HEALTHCARE SYSTEMS - UNICARE
1033435656OtherMULTIPLAN, INC.
1033435656OtherEASTERN SUSSEX PHYSICIANS ORGANIZATION
1033435656OtherCOMMUNITY HEALTH PLAN
1033435656OtherBLUE CROSS BLUE SHIELD OF DELAWARE
1033435656OtherPERDUE FARMS, INC.
1033435656OtherPRIVATE HEALTHCARE SYSTEMS - UNICARE