Individual
DR. CHARLES C. MOORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7603 FOREST AVE, SUITE 403, RICHMOND, VA 23229-4942
(804) 741-0440
(804) 288-2277
Mailing address
PO BOX 11768, RICHMOND, VA 23230-0168
(804) 353-4000
(804) 213-9783
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0101024051
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006203035
—
VA
01
—
C06527
MEDICARE GROUP NUMBER
—
Enumeration date
03/24/2006
Last updated
09/25/2014
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