Individual
LAURA LOOMER MOYLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1930 BRAEBURN DR, SUITE B, SALEM, VA 24153-7391
(540) 776-6800
(540) 776-2919
Mailing address
6008 CAVALIER DR, ROANOKE, VA 24018-3880
(540) 772-6920
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101044609
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
282028
BCBS PROVIDER NUMBER
VA
01
—
54-1832336
TAX ID #
VA
05
—
6209718
—
VA
Enumeration date
04/09/2006
Last updated
10/22/2010
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