Provider Demographics
NPI:1407060346
Name:MOORE, RICHARD CARROLL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CARROLL
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1849 W PLAZA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6365
Mailing Address - Country:US
Mailing Address - Phone:540-450-0233
Mailing Address - Fax:540-450-0235
Practice Address - Street 1:1849 W PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-450-0233
Practice Address - Fax:540-450-0235
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G52483Medicare UPIN