Individual
MARITA L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1272 W MAIN ST STE 206, NEWARK, OH 43055-2060
(220) 564-4824
(220) 564-1896
Mailing address
1272 W MAIN ST STE 206, NEWARK, OH 43055-2060
(220) 564-4824
(220) 564-1896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-098387
IL
207Q00000X
Family Medicine Physician
Primary
35.094506
OH
207Q00000X
Family Medicine Physician
36336
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0473009
—
IA
05
—
3049883
—
OH
Enumeration date
10/11/2006
Last updated
03/18/2021
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