Provider Demographics
NPI:1861480428
Name:O'MOORE, PAUL V (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:V
Last Name:O'MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6750
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03802-6750
Mailing Address - Country:US
Mailing Address - Phone:800-208-7069
Mailing Address - Fax:610-956-0009
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-3926
Practice Address - Fax:215-542-7936
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049403L2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014004730001Medicaid
PA300047238Medicare PIN
PAP00147064Medicare PIN
C06401Medicare UPIN
PA154012F66Medicare PIN
PA154012D2HMedicare PIN