Provider Demographics
NPI:1538134606
Name:MOORE, SHERI N (DO)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:N
Last Name:MOORE
Suffix:
Gender:F
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:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629
Mailing Address - Country:US
Mailing Address - Phone:410-479-4306
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:609 DAFFIN LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629
Practice Address - Country:US
Practice Address - Phone:410-479-2650
Practice Address - Fax:410-479-1626
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH60809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7083515OtherAETNA
MD521116591OtherTRICARE
MD6178544OtherCIGNA
MD62162901OtherCAREFIRST BC/BS RENDERING
MDT5880023OtherCF BC/BS GRP/GHMSI/BL CHO
MD121247OtherPRIORITY PARTNERS
MD2115772OtherMAMSI/ALLIANCE
MD745317OtherCOVENTRY
MD8115772OtherOPTIMUM CHOICE/MDIPA
MD521116591OtherMARYLAND PHYSICIANS CARE
MDP16115OtherCAREFIRST BC/BS POS
MD735699OtherNCPPO
MD521116591OtherINFORMED
MD784381000Medicaid
MD784381000Medicaid
MD521116591OtherTRICARE
MD62162901OtherCAREFIRST BC/BS RENDERING