Provider Demographics
NPI:1477597763
Name:MONEYMAKER, CAROLYN S (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:MONEYMAKER
Suffix:
Gender:F
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:PO BOX 741622
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1622
Mailing Address - Country:US
Mailing Address - Phone:757-668-7179
Mailing Address - Fax:757-668-9810
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7179
Practice Address - Fax:757-668-9810
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101053458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6905194Medicaid
VA006732780Medicaid
NC6905194Medicaid