=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316269285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHEL GUY MOREAU MD, ND
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2010
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1004 FIRST COLONIAL RD STE 102
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23454-3070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-792-7150
-----------------------------------------------------
Fax | 757-707-8873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1004 FIRST COLONIAL RD STE 102
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23454-3070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-792-7150
-----------------------------------------------------
Fax | 757-707-8873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 0990119265
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 0101266902
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------