Provider Demographics
NPI:1669532347
Name:MOORE, JAVAKA K (MD)
Entity type:Individual
Prefix:DR
First Name:JAVAKA
Middle Name:K
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7610 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747
Mailing Address - Country:US
Mailing Address - Phone:301-669-1870
Mailing Address - Fax:301-669-1873
Practice Address - Street 1:7525 GREENWAY CENTER DRIVE
Practice Address - Street 2:SUITE 216
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-486-1870
Practice Address - Fax:301-669-1873
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0065087207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0065087OtherMEDICAL LICENSE
MDD0065087OtherMEDICAL LICENSE