Provider Demographics
NPI:1386461648
Name:MOORE, CHRISTIAN
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BIRCHARD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2967
Mailing Address - Country:US
Mailing Address - Phone:419-552-1254
Mailing Address - Fax:567-201-2156
Practice Address - Street 1:410 BIRCHARD AVE FL 2
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2967
Practice Address - Country:US
Practice Address - Phone:419-552-1254
Practice Address - Fax:567-201-2156
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator