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NPI Code Detail

MEDICARE: RICHARD HENNING MOORE MD

MEDICARE: RICHARD HENNING MOORE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician0101037610VA

General Provider Information

NPI Number : 1093743965
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD HENNING MOORE MD
Provider Business Mailing Address
First Line : 406 ALGONQUIN CT
Second Line :
City : BLACKSBURG
State : VA
Zip : 24060-7871
Country : US
Telephone Number : 540-392-5222
Fax Number :
Provider Business Practice Location Address
First Line : 200 HOSPITAL DR
Second Line :
City : GALAX
State : VA
Zip : 24333-2227
Country : US
Telephone Number : 276-236-8181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 12/10/2015

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