Individual
TARA MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1410 FERN CREEK DR, STATESVILLE, NC 28625-9376
(704) 978-2379
(704) 978-2380
Mailing address
1410 FERN CREEK DR, STATESVILLE, NC 28625-9376
(704) 978-2379
(704) 978-2380
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2015-01302
NC
Other
Enumeration date
06/26/2012
Last updated
09/10/2020
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