Provider Demographics
NPI:1578559415
Name:MOORE, MEREDITH L (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:46 MARKFIELD DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6982
Practice Address - Country:US
Practice Address - Phone:843-556-7048
Practice Address - Fax:843-556-2938
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMD21491207K00000X
SC21491208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC214912Medicaid
NCPENDINGOtherMEDICARE PTAN