Provider Demographics
NPI:1811381783
Name:MOORE, DARIN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11490 ACTON LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-9412
Mailing Address - Country:US
Mailing Address - Phone:301-412-0772
Mailing Address - Fax:
Practice Address - Street 1:11490 ACTON LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-9412
Practice Address - Country:US
Practice Address - Phone:301-412-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0000640283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital