Individual
CHARLOTTE A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1405 KILN CREEK PARKWAY, STE K, NEWPORT NEWS, VA 23602
(757) 369-5784
(757) 369-5785
Mailing address
860 OMNI BLVD, SUITE 303, NEWPORT NEWS, VA 23606
(757) 232-8777
(757) 232-8866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102201212
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275512360
—
VA
Enumeration date
01/17/2006
Last updated
10/05/2012
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