Provider Demographics
NPI:1669535951
Name:MOORE, LYNNETTE (MD)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:MOORE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7525 TIDEWATER DR STE 19
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3700
Mailing Address - Country:US
Mailing Address - Phone:757-330-0150
Mailing Address - Fax:877-487-3044
Practice Address - Street 1:7525 TIDEWATER DR STE 19
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3700
Practice Address - Country:US
Practice Address - Phone:757-330-0150
Practice Address - Fax:877-487-3044
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101054405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine