Provider Demographics
NPI:1972597839
Name:MOELLER, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MOELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-763-5182
Mailing Address - Fax:910-763-0291
Practice Address - Street 1:1515 DOCTORS CIR
Practice Address - Street 2:BUILDING C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7403
Practice Address - Country:US
Practice Address - Phone:910-763-5182
Practice Address - Fax:910-763-0291
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC32405207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110065489OtherRAILROAD MEDICARE
NC1972597839Medicaid
NC8959929Medicaid
NC208939BMedicare PIN
NC110065489OtherRAILROAD MEDICARE
NCNC6997AMedicare PIN
NC1972597839Medicaid