Individual
DR. MARISSA MICHELLE MOULTRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
125 HOSPITAL CENTER BLVD STE 110, STAFFORD, VA 22554-6202
(540) 602-6500
Mailing address
125 HOSPITAL CENTER BLVD STE 110, STAFFORD, VA 22554-6202
(540) 602-6500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101265808
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2016
Last updated
06/06/2021
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