Provider Demographics
NPI:1528252020
Name:SLADE-MOORE, THERESA ALINE (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ALINE
Last Name:SLADE-MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:ALINE
Other - Last Name:SLADE-MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12118 FOXHILL LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2323
Mailing Address - Country:US
Mailing Address - Phone:240-432-0368
Mailing Address - Fax:877-991-8354
Practice Address - Street 1:4601 MARTIN LUTHER KING JR AVE SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1131
Practice Address - Country:US
Practice Address - Phone:202-574-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 0057823207R00000X
DCMD33908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine