Provider Demographics
NPI:1629032172
Name:MOORE, LEROY C (MD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:C
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5750 CENTRE AVE STE 395
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3729
Mailing Address - Country:US
Mailing Address - Phone:412-688-6414
Mailing Address - Fax:
Practice Address - Street 1:5750 CENTRE AVE STE 395
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3729
Practice Address - Country:US
Practice Address - Phone:412-688-6414
Practice Address - Fax:412-945-7220
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027596E207RC0000X, 207UN0901X
VA0101281205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0891781Medicaid
WV0085901000Medicaid
PA0009489610003Medicaid
PA042593GXEMedicare PIN
PAB96701Medicare UPIN