Provider Demographics
NPI:1235471467
Name:MOORE, ALEXANDER GLEN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GLEN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5614 WALNUT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-2439
Mailing Address - Country:US
Mailing Address - Phone:757-439-2058
Mailing Address - Fax:
Practice Address - Street 1:5614 WALNUT ST
Practice Address - Street 2:APT 1
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-2439
Practice Address - Country:US
Practice Address - Phone:757-439-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program