Provider Demographics
NPI:1528113040
Name:CYNTHIA J. MOORMAN, M.D., P.A.
Entity type:Organization
Organization Name:CYNTHIA J. MOORMAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MOORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-662-4868
Mailing Address - Street 1:77 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4893
Mailing Address - Country:US
Mailing Address - Phone:301-662-4868
Mailing Address - Fax:301-662-4200
Practice Address - Street 1:77 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE K
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4893
Practice Address - Country:US
Practice Address - Phone:301-662-4868
Practice Address - Fax:301-662-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054731208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDA7824OtherMEDICARE RAILROAD
E62195Medicare UPIN
MDDA7824OtherMEDICARE RAILROAD