Provider Demographics
NPI:1083839120
Name:MOORE, LOLONYA R (MD)
Entity Type:Individual
Prefix:
First Name:LOLONYA
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOLONYA
Other - Middle Name:R
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30701 WOODWARD AVENUE
Mailing Address - Street 2:SUITE S200
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-584-7600
Mailing Address - Fax:248-584-7606
Practice Address - Street 1:30701 WOODWARD AVE
Practice Address - Street 2:SUITE S200
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0987
Practice Address - Country:US
Practice Address - Phone:248-584-7600
Practice Address - Fax:248-584-7606
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084006174400000X
MI430184006207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology