Provider Demographics
NPI:1104416973
Name:MOORE, MARION ALICE
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:ALICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2801
Mailing Address - Country:US
Mailing Address - Phone:412-944-7897
Mailing Address - Fax:412-664-0109
Practice Address - Street 1:500 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2801
Practice Address - Country:US
Practice Address - Phone:412-944-7897
Practice Address - Fax:412-664-0109
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10976175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist