Provider Demographics
NPI:1629794417
Name:MOORE, EVAN THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:THOMAS
Last Name:MOORE
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:4200 BOSTON CT APT 105
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-5334
Mailing Address - Country:US
Mailing Address - Phone:740-278-5489
Mailing Address - Fax:
Practice Address - Street 1:4075 MONROEVILLE BLVD STE 125
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2526
Practice Address - Country:US
Practice Address - Phone:412-373-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2024-06-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant