Healthcare Provider Details

I. General information

NPI: 1316269285
Provider Name (Legal Business Name): MICHEL GUY MOREAU MD, ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 FIRST COLONIAL RD STE 102
VIRGINIA BEACH VA
23454-3070
US

IV. Provider business mailing address

1004 FIRST COLONIAL RD STE 102
VIRGINIA BEACH VA
23454-3070
US

V. Phone/Fax

Practice location:
  • Phone: 757-792-7150
  • Fax: 757-707-8873
Mailing address:
  • Phone: 757-792-7150
  • Fax: 757-707-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0990119265
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101266902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: