Provider Demographics
NPI:1659300960
Name:MOORE, SUSAN GIBBS (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GIBBS
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:HUNTER
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:4420 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7505
Mailing Address - Country:US
Mailing Address - Phone:919-784-6818
Mailing Address - Fax:919-784-6828
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-6818
Practice Address - Fax:919-784-6828
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01211207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1428FOtherBCBS
NC5904483Medicaid
NC1428FOtherBCBS
NC2056991AMedicare PIN