Provider Demographics
NPI:1730475336
Name:MOORE, MODJULIE ALEXANDRA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MODJULIE
Middle Name:ALEXANDRA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MANNING DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-6119
Mailing Address - Country:US
Mailing Address - Phone:984-974-4882
Mailing Address - Fax:
Practice Address - Street 1:590 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-9436
Practice Address - Country:US
Practice Address - Phone:984-974-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248569207Q00000X
NC2014-01158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730475336OtherTRICARE
NC1885DOtherBCBS
NC1730475336Medicaid
NC5138994OtherUNITEDHEALTHCARE
NC5803998OtherAETNA
NC1730475336OtherMEDCOST
NC4012742OtherCIGNA
NCNCJ758AMedicare PIN