Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OS015726 | PA |
N | 111NI0900X | Internist | OS015726 | PA |
Y | 207RA0401X | Internist - Addiction Medicine | OS015726 | PA |
NPI | 1396906640 |
---|---|
Provider Name | Philip W Moore |
First Address | Camp Hill, PA 17011-2308 |
Second Address | Camp Hill, PA 17011-2308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 11/09/2020 |