NPIMap

Individual provider Active NPI

Parry A. Moore, M.D.

  • Internal Medicine Physician
  • Ellicott City, MD
National Provider Identifier
1760467880
Registry record updated Jan 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0021461 Issued in MD
Practice address
4801 Dorsey Hall Dr
Suite 201
Ellicott City, MD 21042-7766
Phone
(410) 997-7660
Fax
(410) 997-5377
NPI assigned
Dec 12, 2005
Last updated
Jan 14, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0021461 MD Primary

Addresses

Primary practice location

4801 Dorsey Hall Dr
Suite 201
Ellicott City, MD 21042-7766

Mailing address

4801 Dorsey Hall Dr
Suite 201
Ellicott City, MD 21042-7766
Phone (410) 997-7660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041111001039 MD Practitioner - Internal Medicine 7416911219 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Maryland School of Medicine, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lifebridge Medical Associates LLCGroup PAC ID 0446470165, 18 clinicians

Practice addresses (Care Compare)

4801 Dorsey Hall Dr
Suite 201
Ellicott City, MD 21042-7749
Phone (443) 393-3788

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
D0021461MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebridge Medical Associates, LLC Internal Medicine CurrentSince Aug 1, 2014 Accepting new patients
University of Maryland Pediatric Associates, PA Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4801 Dorsey Hall Dr
#G
Ellicott City, MD 21042
Phone (443) 393-3788

4801 Dorsey Hall Dr
Ste 201
Ellicott City, MD 21042
Phone (410) 997-5191

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1134345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263427200000",
    "number": "1760467880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 DORSEY HALL DR",
            "address_2": "SUITE 201",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427766",
            "telephone_number": "410-997-7660",
            "fax_number": "410-772-0257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 DORSEY HALL DR",
            "address_2": "SUITE 201",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427766",
            "telephone_number": "410-997-7660",
            "fax_number": "410-997-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "PARRY",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-12",
        "last_updated": "2010-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0021461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.