Provider Demographics
NPI:1902192503
Name:MOORE, RICHARD ANTHONY II (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:MOORE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3708 MAYFAIR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6223
Mailing Address - Country:US
Mailing Address - Phone:984-215-4780
Mailing Address - Fax:984-215-4785
Practice Address - Street 1:3708 MAYFAIR ST STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6223
Practice Address - Country:US
Practice Address - Phone:984-215-4780
Practice Address - Fax:984-215-4785
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248568207Q00000X
NC2014-01370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902192503OtherTRICARE
NC1902192503Medicaid
NC1888MOtherBCBS OF NC
NC4905686OtherAETNA
NC5140629OtherUNITEDHEALTHCARE
NC1902192503OtherMEDCOST
NC5325277OtherCIGNA