Provider Demographics
NPI:1821509530
Name:MOORE, PAULA D
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10513 STORCH DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2185
Mailing Address - Country:US
Mailing Address - Phone:202-706-2229
Mailing Address - Fax:
Practice Address - Street 1:10513 STORCH DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2185
Practice Address - Country:US
Practice Address - Phone:202-706-2229
Practice Address - Fax:202-706-2229
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility