MEDICARE: TRAMAINE MOULTRIE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1942057971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAMAINE MOULTRIE

Provider Business Mailing Address
First Line	:	1001 LESLIE ANN DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-2209
Country	:	US
Telephone Number	:	804-253-2674
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 LESLIE ANN DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-2209
Country	:	US
Telephone Number	:	804-253-2674
Fax Number	:

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

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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Directions to “ TRAMAINE MOULTRIE ” Practice Location

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