Provider Demographics
NPI:1730101130
Name:MOORE, SHARON KELLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:KELLEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6501 N. CHARLES STREET
Mailing Address - Street 2:SHEPPARD PRATT PHYSICIANS, PA
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3461
Mailing Address - Fax:410-938-3461
Practice Address - Street 1:6501 N. CHARLES STREET
Practice Address - Street 2:SHEPPARD PRATT PHYSICIANS, PA
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6819
Practice Address - Country:US
Practice Address - Phone:410-938-3461
Practice Address - Fax:410-938-3461
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012214172084P0800X
MDD680612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79538Medicare UPIN