Provider Demographics
NPI:1336430982
Name:MOORE, STEVEN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTHONY
Last Name:MOORE
Suffix:
Gender:M
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1260
Mailing Address - Fax:
Practice Address - Street 1:9101 MONROE RD
Practice Address - Street 2:SUITE 155
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2467
Practice Address - Country:US
Practice Address - Phone:704-384-1260
Practice Address - Fax:704-384-1289
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC172848OtherRESIDENT LICENSE NUMBER
NC172848OtherRESIDENT LICENSE NUMBER