Provider Demographics
NPI:1497800403
Name:MOORE, FREDERICK DM (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:DM
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARSHALL
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:501 HUNGERFORD DR APT 461
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5154
Mailing Address - Country:US
Mailing Address - Phone:860-857-5827
Mailing Address - Fax:
Practice Address - Street 1:501 HUNGERFORD DR APT 461
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5154
Practice Address - Country:US
Practice Address - Phone:860-857-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054731A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery