Individual
JOHANNA L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
130 S BRYN MAWR AVE, BRYN MAWR, PA 19010
(610) 526-3583
(610) 526-3614
Mailing address
PO BOX 3012, WILMINGTON, DE 19804
(800) 456-4629
(302) 224-2848
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA002613L
PA
Other
Enumeration date
02/17/2006
Last updated
06/28/2019
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