Provider Demographics
NPI:1740209253
Name:MOORE, CHARLES F JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:MOORE
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3897 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9562
Mailing Address - Country:US
Mailing Address - Phone:502-495-3665
Mailing Address - Fax:502-874-5536
Practice Address - Street 1:3897 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9562
Practice Address - Country:US
Practice Address - Phone:502-495-3665
Practice Address - Fax:502-874-5536
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41169207R00000X, 207RR0500X
IN01056663A208M00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00248435OtherRR MCARE PIN
IN200518340Medicaid
KY64102056Medicaid
INP00248435OtherRR MCARE PIN
IN200518340Medicaid
IN000000386253OtherBCBS - GATEWAY
I30470Medicare UPIN
IN639620AAAMedicare ID - Type Unspecified