Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 35124167 | OH |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | N9607 | TX |
N | 2081S0010X | Sports Medicine | A108599 | CA |
N | 213ES0000X | Sports Medicine | A108599 | CA |
Y | 2081S0010X | Sports Medicine | D0084055 | MD |
Y | 213ES0000X | Sports Medicine | D0084055 | MD |
NPI | 1225171929 |
---|---|
Provider Name | Dr. Melita N Moore |
First Address | Baltimore, MD 21218 |
Second Address | Baltimore, MD 21218-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 05/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124167 | LICENSURE (01) | OH |
A108599 | LICENSURE (01) | CA |
D0084055 | LICENSURE (01) | MD |
N9607 | LICENSE (01) | TX |