Provider Demographics
NPI:1427062116
Name:MOORE, ANDREW E (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1262
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:1270 N POST RD
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4209
Practice Address - Country:US
Practice Address - Phone:317-895-6095
Practice Address - Fax:317-895-6195
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027125A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194370OtherMEDICAID GROUP NUMBER
IN000000091687OtherANTHEM PIN NUMBER
IN100071440Medicaid
IN1487680518OtherGROUP NPI
IN340017159OtherMEDICARE RAILROAD
IN677730MMMMedicare PIN
IN340017159OtherMEDICARE RAILROAD
IN100194370OtherMEDICAID GROUP NUMBER
IN000000091687OtherANTHEM PIN NUMBER