Individual
CLEN DAMON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
46440 BENEDICT DR, STE 207, STERLING, VA 20164-6602
(703) 444-2100
(703) 444-0386
Mailing address
PO BOX 17334, BALTIMORE, MD 21297-1334
(703) 443-6717
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101056399
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710982640
—
VA
Enumeration date
06/16/2005
Last updated
03/29/2011
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