Provider Demographics
NPI:1528200128
Name:MOORE, JOEL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:RICHARD
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:EAST COOPER MEDICAL CENTER 2000 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-416-6100
Mailing Address - Fax:585-473-3516
Practice Address - Street 1:EAST COOPER MEDICAL CENTER 2000 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-416-6100
Practice Address - Fax:585-473-3516
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN48177207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program