Provider Demographics
NPI:1821831017
Name:GROSS-MOORE, IDA
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:GROSS-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 1:739 QUAPAW CT
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-4837
Mailing Address - Country:US
Mailing Address - Phone:202-568-2333
Mailing Address - Fax:
Practice Address - Street 1:739 QUAPAW CT
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-4837
Practice Address - Country:US
Practice Address - Phone:202-568-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care