Provider Demographics
NPI:1801895925
Name:MOORE, DAVID HUTCHINSON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HUTCHINSON
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-741-9063
Mailing Address - Fax:717-718-9779
Practice Address - Street 1:2675 JOPPA RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5160
Practice Address - Country:US
Practice Address - Phone:717-741-9063
Practice Address - Fax:717-718-9779
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABM3176903208000000X
PAMD046624L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012878860001Medicaid
G04231Medicare UPIN