Basic Information
| Provider Information | |||||||||
| NPI: | 1538134606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | SHERI | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 660 | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104794306 | ||||||||
| FaxNumber: | 4104791714 | ||||||||
| Practice Location | |||||||||
| Address1: | 609 DAFFIN LN | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104792650 | ||||||||
| FaxNumber: | 4104791626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 06/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | H60809 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7083515 | 01 | MD | AETNA | OTHER | 521116591 | 01 | MD | TRICARE | OTHER | 6178544 | 01 | MD | CIGNA | OTHER | 62162901 | 01 | MD | CAREFIRST BC/BS RENDERING | OTHER | T5880023 | 01 | MD | CF BC/BS GRP/GHMSI/BL CHO | OTHER | 121247 | 01 | MD | PRIORITY PARTNERS | OTHER | 2115772 | 01 | MD | MAMSI/ALLIANCE | OTHER | 745317 | 01 | MD | COVENTRY | OTHER | 8115772 | 01 | MD | OPTIMUM CHOICE/MDIPA | OTHER | 521116591 | 01 | MD | MARYLAND PHYSICIANS CARE | OTHER | P16115 | 01 | MD | CAREFIRST BC/BS POS | OTHER | 735699 | 01 | MD | NCPPO | OTHER | 521116591 | 01 | MD | INFORMED | OTHER | 784381000 | 05 | MD | MEDICAID |