Provider Demographics
NPI:1275687493
Name:MOORE, CHARLES E II (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:MOORE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-0257
Mailing Address - Country:US
Mailing Address - Phone:410-869-3344
Mailing Address - Fax:410-869-3340
Practice Address - Street 1:4 E ROLLING CROSSROADS
Practice Address - Street 2:102
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6210
Practice Address - Country:US
Practice Address - Phone:410-869-3344
Practice Address - Fax:410-869-3340
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2011-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDDOO35330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMA280251100Medicaid
MDMA280251100Medicaid