Provider Demographics
NPI:1336540434
Name:MOOR, RACHEL E (PA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:MOOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VAIL AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1219
Mailing Address - Country:US
Mailing Address - Phone:704-304-7000
Mailing Address - Fax:704-304-7008
Practice Address - Street 1:2001 VAIL AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1219
Practice Address - Country:US
Practice Address - Phone:704-304-7000
Practice Address - Fax:704-304-7008
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2003PAMedicaid
NC1336540434Medicaid
NC1336540434Medicaid
NCNCL127DMedicare PIN
NCNCL127BMedicare PIN
SC2003PAMedicaid