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General NPI Number Information
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NPI Number | 1366641672
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Entity Type | Individual
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Provider Name | SUSAN CAROL MOOSE DO
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Gender | Female
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 759 S MAIN ST SUITE 300
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City | WOODSTOCK
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State | VA
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Zip | 22664-1127
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Country | US
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Telephone | 540-459-1540
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Fax | 540-459-1486
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Provider Business Mailing Address
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Address Line | 136 LINDEN DR SUITE 104
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City | WINCHESTER
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State | VA
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Zip | 22601-6900
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Country | US
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Telephone | 540-678-3588
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Fax | 540-678-9025
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0116017646
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License Number State | VA
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