Healthcare Provider Details

I. General information

NPI: 1699112409
Provider Name (Legal Business Name): DENEE J MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 07/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PRESTON AVE SUITE 301
CHARLOTTESVILLE VA
22903-4491
US

IV. Provider business mailing address

901 PRESTON AVE SUITE 301
CHARLOTTESVILLE VA
22903-4491
US

V. Phone/Fax

Practice location:
  • Phone: 434-227-5624
  • Fax: 434-970-7700
Mailing address:
  • Phone: 434-227-5624
  • Fax: 434-970-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101259437
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: