Provider Demographics
NPI:1063702371
Name:MOORE, LINDSEY NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:NICOLE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 MEDICAL PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3207
Mailing Address - Country:US
Mailing Address - Phone:330-365-9825
Mailing Address - Fax:
Practice Address - Street 1:400 MEDICAL PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622
Practice Address - Country:US
Practice Address - Phone:330-365-9825
Practice Address - Fax:330-364-3282
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.124199207N00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program