Provider Demographics
NPI:1164617353
Name:MOORE, DAPHNE I
Entity Type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:I
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7548 ROLLING HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23860-8000
Mailing Address - Country:US
Mailing Address - Phone:804-519-6109
Mailing Address - Fax:
Practice Address - Street 1:7548 ROLLING HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23860-8000
Practice Address - Country:US
Practice Address - Phone:804-519-6109
Practice Address - Fax:804-326-2934
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)