Provider Demographics
NPI:1033435656
Name:MOORE, AMANDA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-0607
Mailing Address - Country:US
Mailing Address - Phone:302-424-4141
Mailing Address - Fax:302-422-6506
Practice Address - Street 1:329 MULLET RUN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5373
Practice Address - Country:US
Practice Address - Phone:410-749-4154
Practice Address - Fax:410-860-9583
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0000701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
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1033435656OtherPERDUE FARMS, INC.
1033435656OtherHEALTH NET FEDERAL SERVICES - TRICARE/CHAMPUS
1033435656OtherCOMMUNITY HEALTH PLAN
1033435656OtherPERDUE FARMS, INC.
1033435656OtherPRIVATE HEALTHCARE SYSTEMS - UNICARE