Provider Demographics
NPI:1437688090
Name:MOORE, DEVORA BELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEVORA
Middle Name:BELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 OXON HILL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3168
Mailing Address - Country:US
Mailing Address - Phone:301-567-5005
Mailing Address - Fax:
Practice Address - Street 1:7610 CARROLL AVE STE 230
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6312
Practice Address - Country:US
Practice Address - Phone:301-891-2303
Practice Address - Fax:301-891-2487
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301319213E00000X, 213E00000X
MD01715213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery