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General NPI Number Information
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NPI Number | 1982881306
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Entity Type | Individual
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Provider Name | RUSSELL ADRIAN MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 633 SUNSET LN
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City | CULPEPER
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State | VA
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Zip | 22701-3942
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Country | US
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Telephone | 540-829-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 21ST ST NW
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City | WASHINGTON
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State | DC
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Zip | 20036-1503
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Country | US
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Telephone |
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101231046
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License Number State | VA
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