Provider Demographics
NPI:1508901851
Name:MOORE, TERENCE NEAL (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:NEAL
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 1:1576 SPINNAKER LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-9659
Mailing Address - Country:US
Mailing Address - Phone:843-763-2281
Mailing Address - Fax:
Practice Address - Street 1:1576 SPINNAKER LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-9659
Practice Address - Country:US
Practice Address - Phone:843-763-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC73892085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC32190Medicare UPIN