Provider Demographics
NPI:1235024712
Name:MOORE OBGYN LLC
Entity type:Organization
Organization Name:MOORE OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-669-1870
Mailing Address - Street 1:7610 PENNSYLVANIA AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4764
Mailing Address - Country:US
Mailing Address - Phone:301-669-1870
Mailing Address - Fax:301-669-1873
Practice Address - Street 1:2045 UNIVERSITY BLVD E STE 102
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4137
Practice Address - Country:US
Practice Address - Phone:301-669-1870
Practice Address - Fax:301-669-1870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOORE OBGYN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty