Provider Demographics
NPI:1730435801
Name:MOORE-WOOD, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MOORE-WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 WADSWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3109
Mailing Address - Country:US
Mailing Address - Phone:443-621-0197
Mailing Address - Fax:
Practice Address - Street 1:1810 WADSWORTH WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3109
Practice Address - Country:US
Practice Address - Phone:443-621-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDNDB07262012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNDB07262012OtherDMEHS