Provider Demographics
NPI:1962498501
Name:MOORE, BARRY BROOKS (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:BROOKS
Last Name: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 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 CENTURY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-8417
Practice Address - Country:US
Practice Address - Phone:717-697-5800
Practice Address - Fax:717-697-2719
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013303E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50073727OtherBLUE CROSS
PA0008007390002Medicaid
PA142640OtherHIGHMARK BLUE SHIELD
PA228135OtherUNISON
PA4547288OtherAETNA
PA7142640OtherGATEWAY
PA18525OtherGEISINGER
PA50073727OtherBLUE CROSS
PA0008007390002Medicaid