Roberta Maureen Moreland, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0101049184 Issued in VA

Practice address

19415 Deerfield Ave
Suite 314
Leesburg, VA 20176-8452

Phone

(703) 723-7171

Fax

(703) 723-7176

NPI assigned

Aug 30, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1104819739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17334",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212971334",
            "telephone_number": "703-723-7171",
            "fax_number": "703-723-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19415 DEERFIELD AVE",
            "address_2": "SUITE 314",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201768452",
            "telephone_number": "703-723-7171",
            "fax_number": "703-723-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORELAND",
        "first_name": "ROBERTA",
        "middle_name": "MAUREEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101049184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104819739",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "0700014603",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jodi Marie Moore, CD(DONA)
• Katherine Madsen Moore, LPC
• Latrice Moore, FNP-BC
• Joni Moos, RN
• Ivelisse Morales-Rios
• Stefanie Moreno, LCSW
• John Irvin Morgan IV, MD
• Morningside House of Leesburg
• Lauren Wells Morris, RN, CLC
• Amanda Morrow Badar, LPC

• Dermatology Physician in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Dermatology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.