MEDICARE: HANNAH MOON PA-C

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
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1871184242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH MOON PA-C

Provider Business Mailing Address
First Line	:	1649 GERMAN SCHOOL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4181
Country	:	US
Telephone Number	:	570-204-0574
Fax Number	:

Provider Business Practice Location Address
First Line	:	9030 STONY POINT PKWY STE 450
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1941
Country	:	US
Telephone Number	:	804-500-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	10/07/2024

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Directions to “ HANNAH MOON PA-C” Practice Location

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