Provider Demographics
NPI:1760677827
Name:MOORE, CHARLES SIDNEY JR (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:SIDNEY
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:5100 W TILGHMAN ST STE 315
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9166
Mailing Address - Country:US
Mailing Address - Phone:610-395-4044
Mailing Address - Fax:610-395-5693
Practice Address - Street 1:2851 BAGLYOS CIR STE 100
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020
Practice Address - Country:US
Practice Address - Phone:484-821-0550
Practice Address - Fax:484-821-0559
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2019-11-06
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Provider Licenses
StateLicense IDTaxonomies
PARN538686367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered