Provider Demographics
NPI:1427020403
Name:MOY, PETER M (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:MOY
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 1:397 LITTLE NECK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5765
Mailing Address - Country:US
Mailing Address - Phone:757-470-5570
Mailing Address - Fax:757-227-3377
Practice Address - Street 1:397 LITTLE NECK RD, 3300 SOUTH BLDG
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-470-5570
Practice Address - Fax:757-227-3377
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ591792086S0129X
VA01010515112086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007313837Medicaid
020054467OtherMEDICARE RAILROAD
VA007313837Medicaid
001247V96Medicare ID - Type Unspecified