Provider Demographics
NPI:1164857512
Name:MOORE OBGYN LLC
Entity Type:Organization
Organization Name:MOORE OBGYN LLC
Other - Org Name:MOORE OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAVAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-669-1870
Mailing Address - Street 1:7610 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4701
Mailing Address - Country:US
Mailing Address - Phone:301-669-1870
Mailing Address - Fax:301-669-1873
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 216
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-486-1870
Practice Address - Fax:301-669-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty