Provider Demographics
NPI:1972580462
Name:MOORE, JAMES THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:THOMAS
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 1:1208 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3706
Mailing Address - Country:US
Mailing Address - Phone:215-887-3565
Mailing Address - Fax:
Practice Address - Street 1:1208 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3706
Practice Address - Country:US
Practice Address - Phone:215-887-3565
Practice Address - Fax:215-887-0448
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-025657E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1002111OtherAETNA
PA265028OtherBLUE CROSS BLUE SHIELD
PA0045129000OtherKEYSTONE
PA020039062OtherRAILROAD MEDICARE
PA1087030002OtherCIGNA
PA0018609380001Medicaid
PAC29391Medicare UPIN
PA1087030002OtherCIGNA