Provider Demographics
NPI:1083853428
Name:MOORE, MOLLY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HAMMOCKS DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1683
Mailing Address - Country:US
Mailing Address - Phone:716-310-2015
Mailing Address - Fax:
Practice Address - Street 1:205 HAMMOCKS DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1683
Practice Address - Country:US
Practice Address - Phone:716-310-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269744-12086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care