Provider Demographics
NPI:1225014178
Name:MOORE, TODD ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ANTHONY
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-6517
Mailing Address - Country:US
Mailing Address - Phone:910-691-2238
Mailing Address - Fax:
Practice Address - Street 1:220 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8748
Practice Address - Country:US
Practice Address - Phone:910-715-3000
Practice Address - Fax:910-715-3501
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00284207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00020215Medicaid
FH2967770OtherFIRSTCAROLINACARE
1518MOtherBC/BS NC
NC5911193Medicaid
5517593OtherCIGNA HEALTHCARE
AL51538716Medicaid
SCN00280OtherSC MEDICAID
830000046Medicare ID - Type Unspecified
2073214AMedicare PIN
G52505Medicare UPIN