Provider Demographics
NPI:1346341567
Name:MOORE, GEORGE JOHN (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOHN
Last Name:MOORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 CARROLL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4430
Mailing Address - Country:US
Mailing Address - Phone:301-270-2584
Mailing Address - Fax:301-587-6567
Practice Address - Street 1:7030 CARROLL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4430
Practice Address - Country:US
Practice Address - Phone:301-270-2584
Practice Address - Fax:301-587-6567
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00393412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCA918001OtherBCBS
MD53507801OtherCAREFIRST BCBS
MD53507801OtherCAREFIRST BCBS
DCA918001OtherBCBS