Provider Demographics
NPI:1912220823
Name:GINA C MOORE MD PLC
Entity Type:Organization
Organization Name:GINA C MOORE MD PLC
Other - Org Name:WOMENS CARE OF WARRENTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-341-4102
Mailing Address - Street 1:419 HOLIDAY CT
Mailing Address - Street 2:STE 100A
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-4338
Mailing Address - Country:US
Mailing Address - Phone:540-341-4102
Mailing Address - Fax:540-341-7102
Practice Address - Street 1:419 HOLIDAY CT
Practice Address - Street 2:STE 100A
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-4338
Practice Address - Country:US
Practice Address - Phone:540-341-4102
Practice Address - Fax:540-341-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty