Paul Derek Moore, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD444618 Issued in PA

Practice address

815 Cumberland St
Suite 205
Lebanon, PA 17042-5266

Phone

(717) 277-7400

Fax

(717) 277-7402

NPI assigned

Oct 11, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474588800000",
    "number": "1417945700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N CAMERON ST",
            "address_2": "SUITE 401E",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171012424",
            "telephone_number": "717-232-8535",
            "fax_number": "717-232-8515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 CUMBERLAND ST",
            "address_2": "SUITE 205",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170425266",
            "telephone_number": "717-277-7400",
            "fax_number": "717-277-7402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "PAUL",
        "middle_name": "DEREK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2016-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "40759",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PA",
            "license": "MD444618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09932861",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Moll
• Montague Vision LLC
• Paul Montague, O.D.
• Jacob Moore
• Michelle Moore, LPN
• Susan Moore
• Susan Lynn Moore, NP
• Catharine Morales
• Jeremy Owen Morford
• Jonathan Lee Morren, PT

• General Practice Physician in Lebanon, PA
• Providers in Lebanon, PA by specialty
• General Practice Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; 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.