Provider Demographics
NPI:1730405010
Name:MOORE, LIZA ALEXANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:LIZA
Middle Name:ALEXANDRA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:A
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8200 GREENSBORO DR STE 801
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4925
Mailing Address - Country:US
Mailing Address - Phone:703-942-9787
Mailing Address - Fax:703-563-3824
Practice Address - Street 1:8200 GREENSBORO DR STE 801
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4925
Practice Address - Country:US
Practice Address - Phone:703-942-9787
Practice Address - Fax:703-563-3824
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253466207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty