Provider Demographics
NPI:1194157131
Name:MOORE, DONNICA LAUREN (MD)
Entity type:Individual
Prefix:DR
First Name:DONNICA
Middle Name:LAUREN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ST BERNARDS RD
Mailing Address - Street 2:
Mailing Address - City:FAR HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07931-2727
Mailing Address - Country:US
Mailing Address - Phone:908-234-2702
Mailing Address - Fax:908-234-2703
Practice Address - Street 1:3 ST BERNARDS RD
Practice Address - Street 2:
Practice Address - City:FAR HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07931-2727
Practice Address - Country:US
Practice Address - Phone:908-234-2702
Practice Address - Fax:908-234-2703
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA052403208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice