Provider Demographics
NPI:1114119732
Name:MOORE, ANIKA TENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIKA
Middle Name:TENE
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 1:10506 MONTGOMERY RD STE 504
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:513-221-3800
Mailing Address - Fax:513-682-4520
Practice Address - Street 1:10506 MONTGOMERY RD STE 504
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-221-3800
Practice Address - Fax:513-682-4520
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.141435207V00000X
MA265368207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174859425Medicaid
CAW1508OtherMEDICARE GROUP PTAN
CA1447277355Medicaid
CAW1508GMedicare PIN
CA1447277355Medicaid
CACS324YMedicare PIN