MEDICARE: DR. DAVID S MOORTHI M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	214078	NY
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	214078	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2140788B	OTHER		TRICARE
2	RC60214078	OTHER		POMCO
3	200995527	OTHER		CHAMPUS VA
4	00026146103	OTHER		UNIVERA
5	P010214078	OTHER	NY	BLUECHOICE
6	P020214078	OTHER		EXCELLUS BCBS
7	200995527	OTHER		EMPIRE PLAN
8	786892	OTHER		MVP
9	8799848	OTHER		GHI
10	110836AH	OTHER		PREFERRED CARE
11	200995527	OTHER		CIGNA
12	608856700	OTHER		DOL-OWCP
13	RC60214078	OTHER		NOVA
14	200995527	OTHER		AMERICAN PROGRESSIVE
15	7001141	OTHER		AETNA

General Provider Information

NPI Number	:	1770586653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S MOORTHI M.D

Provider Business Mailing Address
First Line	:	1080 FIRST COLONIAL RD STE 201
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2439
Country	:	US
Telephone Number	:	757-395-6450
Fax Number	:	757-622-2750

Provider Business Practice Location Address
First Line	:	1080 FIRST COLONIAL RD STE 201
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2439
Country	:	US
Telephone Number	:	757-395-6450
Fax Number	:	757-622-2750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/30/2026

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