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General NPI Number Information
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NPI Number | 1730354259
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Entity Type | Organization
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Legal Business Name | CAROLINA CENTER FOR FERTILITY & ENDOCRINOLOGY, PA
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 1410 BLANDING ST SUITE 205
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City | COLUMBIA
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State | SC
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Zip | 29201-2967
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Country | US
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Telephone | 803-779-6320
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Fax | 803-779-6323
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Provider Business Mailing Address
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Address Line | 1410 BLANDING ST SUITE 205
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City | COLUMBIA
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State | SC
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Zip | 29201-2967
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Country | US
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Telephone | 803-779-6320
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Fax | 803-779-6323
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD E. MOORE
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Credential | M.D.
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Telephone | 803-779-6320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 10002
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License Number State | SC
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