Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35138310 | OH |
Y | 208600000X | Surgeon | 35138310 | OH |
N | 2082S0105X | Plastic Hand Surgeon | 35138310 | OH |
N | 2086S0105X | Surgery of the Hand | 2007030788 | MO |
N | 2086S0122X | Plastic and Reconstructive Surgery | 2007030788 | MO |
NPI | 1538381462 |
---|---|
Provider Name | Dr. Amy Marcelle Moore |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43212-3153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 26/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0390307 | (05) | OH |
1538381462 | (05) | MO |
H777590 | MEDICARE-OSU PLASTIC SURGERY, LLC (01) | OH |
H777591 | MEDICARE-OHIO STATE UNIVERSITY ORTHOPEDIC (01) | OH |
H777592 | MEDICARE-CHILDREN'S SURGICAL ASSOCIATES, CORPORATION (01) | OH |