Provider Demographics
NPI:1861672347
Name:MOORE, MARY PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PATRICIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:280 BROAD ST STE E
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2948
Mailing Address - Country:US
Mailing Address - Phone:336-277-6050
Mailing Address - Fax:336-992-3141
Practice Address - Street 1:280 BROAD ST STE E
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2948
Practice Address - Country:US
Practice Address - Phone:336-277-6050
Practice Address - Fax:336-992-3141
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-011422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry