Provider Demographics
NPI:1013503382
Name:MOORE, OPHIONIA
Entity Type:Individual
Prefix:
First Name:OPHIONIA
Middle Name:
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 1:8210 HANDSOME JOE LN APT 303
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-7218
Mailing Address - Country:US
Mailing Address - Phone:240-751-2091
Mailing Address - Fax:
Practice Address - Street 1:8210 HANDSOME JOE LN APT 303
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-7218
Practice Address - Country:US
Practice Address - Phone:240-751-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program