Individual
CHARLES A MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
123 N 19TH ST, SUITE 201, MIDDLESBORO, KY 40965-2865
(606) 248-0090
(606) 248-8803
Mailing address
PO BOX 309, MIDDLESBORO, KY 40965-0309
(606) 248-0090
(606) 248-8803
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22757
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062741
BLUE CROSS OF KY
KY
01
—
000000251586
BLUE CROSS OF VA
VA
01
—
000051203
BLUE CROSS OF TENNESSEE
TN
01
—
006064205
VA MEDICAID
VA
01
—
017423400
BLACK LUNG
KY
05
—
1003816372
—
KY
01
—
110196198
RAIL ROAD MEDICARE
KY
01
—
1143
CHA
KY
01
—
1326780
UMWA
KY
01
—
1635649000
DEPARTMENT OF LABOR
KY
01
—
1659551935
MEDICARE GROUP NPI
KY
01
—
4176527
TENNESSE MEDICAID
TN
05
—
64227572
—
KY
Enumeration date
07/28/2005
Last updated
04/27/2010
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