Provider Demographics
NPI:1225171929
Name:MOORE, MELITA N (MD)
Entity Type:Individual
Prefix:DR
First Name:MELITA
Middle Name:N
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 1:201 EAST UNIVERSITY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-554-2000
Mailing Address - Fax:
Practice Address - Street 1:201 EAST UNIVERSITY PARKWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2307
Practice Address - Country:US
Practice Address - Phone:410-554-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9607208100000X
OH35124167208100000X
CAA1085992081S0010X
MDD00840552081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA108599OtherLICENSURE
OH124167OtherLICENSURE
MDD0084055OtherLICENSURE
TXN9607OtherLICENSE