Provider Demographics
NPI:1255323622
Name:MOORE, BARRY ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ALLEN
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 1:311 JUDGES RD
Mailing Address - Street 2:BUILDING 4E
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3651
Mailing Address - Country:US
Mailing Address - Phone:910-791-6767
Mailing Address - Fax:910-399-2190
Practice Address - Street 1:311 JUDGES RD
Practice Address - Street 2:BUILDING 4E
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3651
Practice Address - Country:US
Practice Address - Phone:910-791-6767
Practice Address - Fax:910-399-2190
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC195202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891175PMedicaid
NC1175POtherBCBSNC
NC1175POtherBCBSNC
NC202233IMedicare ID - Type Unspecified
NC891175PMedicaid
D33026Medicare UPIN