Provider Demographics
NPI:1700042215
Name:MOORMAN, CHAD D (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:D
Last Name:MOORMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 QUARLES COURT
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801
Mailing Address - Country:US
Mailing Address - Phone:540-434-1664
Mailing Address - Fax:540-433-5931
Practice Address - Street 1:4165 QUARLES CT
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-3576
Practice Address - Country:US
Practice Address - Phone:540-434-1664
Practice Address - Fax:540-433-5931
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006069213ES0103X
MD01522213ES0103X
VA0103301126213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0636510001Medicare NSC