Provider Demographics
NPI:1689762940
Name:MOORE, NANCY CARROLL (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CARROLL
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1955 OHIO DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4835
Mailing Address - Country:US
Mailing Address - Phone:614-257-5808
Mailing Address - Fax:614-257-5801
Practice Address - Street 1:1955 OHIO DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4835
Practice Address - Country:US
Practice Address - Phone:614-257-5808
Practice Address - Fax:614-257-5801
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine