Provider Demographics
NPI:1407866106
Name:MOORE, MARGARET SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:SUSAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24505-1098
Mailing Address - Country:US
Mailing Address - Phone:434-947-6320
Mailing Address - Fax:434-947-2906
Practice Address - Street 1:521 COLONY RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2105
Practice Address - Country:US
Practice Address - Phone:434-947-6320
Practice Address - Fax:434-947-2906
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010377852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB08748Medicare UPIN