Provider Demographics
NPI:1710919642
Name:MOOMAW, WILLIAM CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:MOOMAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:402 S STERLING ST
Mailing Address - Street 2:CAROLINA ANESTHESIOLOGY AND PAIN MANAGEMENT
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3571
Mailing Address - Country:US
Mailing Address - Phone:828-433-8373
Mailing Address - Fax:828-433-8070
Practice Address - Street 1:402 S STERLING ST
Practice Address - Street 2:CAROLINA ANESTHESIOLOGY AND PAIN MANAGEMENT
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3571
Practice Address - Country:US
Practice Address - Phone:828-433-8373
Practice Address - Fax:828-433-8070
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9900105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2263379AOtherMEDICARE
NC891185EMedicaid
NC891185EMedicaid