Provider Demographics
NPI:1376244780
Name:MOORE, SAMUEL ARC'HIE III
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ARC'HIE
Last Name:MOORE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3102
Mailing Address - Country:US
Mailing Address - Phone:202-222-5526
Mailing Address - Fax:
Practice Address - Street 1:2803 63RD AVE
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-3102
Practice Address - Country:US
Practice Address - Phone:202-222-5526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor