Provider Demographics
NPI:1467688507
Name:MOORE, VIRGINIA MARILYN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MARILYN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7550 TEAGUE RD
Mailing Address - Street 2:500
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1339
Mailing Address - Country:US
Mailing Address - Phone:410-981-4598
Mailing Address - Fax:410-981-4010
Practice Address - Street 1:7550 TEAGUE RD
Practice Address - Street 2:500
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1339
Practice Address - Country:US
Practice Address - Phone:410-981-4598
Practice Address - Fax:410-981-4010
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056804208000000X
DC33844208000000X
VA0101229835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics