Healthcare Provider Details

I. General information

NPI: 1457351918
Provider Name (Legal Business Name): ROY MOREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 PARKWAY
GREENSBORO NC
27401-1644
US

IV. Provider business mailing address

411 PARKWAY
GREENSBORO NC
27401-1644
US

V. Phone/Fax

Practice location:
  • Phone: 336-574-0464
  • Fax: 336-574-0467
Mailing address:
  • Phone: 336-574-0464
  • Fax: 336-574-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9400106
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: