Individual
TIMOTHY E. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13207 RAVENNA RD, CHARDON, OH 44024-7032
(440) 285-6000
(216) 844-5922
Mailing address
24701 EUCLID AVE, THIRD FLOOR, EUCLID, OH 44117-1714
(440) 285-6000
(216) 844-5922
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35-082645
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0304914
BCMH
OH
05
—
2437385
—
OH
01
—
P00358817
RAILROAD MEDICARE
OH
Enumeration date
07/17/2006
Last updated
12/27/2011
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