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NPI Code Detail

MEDICARE: DR. DAVID TIPTON MOODY M.D.

MEDICARE: DR. DAVID TIPTON MOODY M.D.
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
12084P0800XPsychiatry Physician0101032087VA

General Provider Information

NPI Number : 1710901897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID TIPTON MOODY M.D.
Provider Business Mailing Address
First Line : 800 PRESTON AVE.
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22903-4420
Country : US
Telephone Number : 434-972-1845
Fax Number : 434-970-1374
Provider Business Practice Location Address
First Line : 800 PRESTON AVE.
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22903-4420
Country : US
Telephone Number : 434-972-1845
Fax Number : 434-970-1374
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/08/2007

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