Healthcare Provider Details

I. General information

NPI: 1710901897
Provider Name (Legal Business Name): DAVID TIPTON MOODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRESTON AVE.
CHARLOTTESVILLE VA
22903-4420
US

IV. Provider business mailing address

800 PRESTON AVE.
CHARLOTTESVILLE VA
22903-4420
US

V. Phone/Fax

Practice location:
  • Phone: 434-972-1845
  • Fax: 434-970-1374
Mailing address:
  • Phone: 434-972-1845
  • Fax: 434-970-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101032087
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: