Provider Demographics
NPI:1194378182
Name:MOORE, EMILY J (RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758997
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8997
Mailing Address - Country:US
Mailing Address - Phone:804-281-0626
Mailing Address - Fax:804-662-7302
Practice Address - Street 1:1200 E BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5058
Practice Address - Country:US
Practice Address - Phone:804-828-0970
Practice Address - Fax:804-628-0204
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered