Provider Demographics
NPI:1912990334
Name:MOELLER, GARLAND RADFORD (MD)
Entity Type:Individual
Prefix:
First Name:GARLAND
Middle Name:RADFORD
Last Name:MOELLER
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 896206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6206
Mailing Address - Country:US
Mailing Address - Phone:252-447-7088
Mailing Address - Fax:252-447-2752
Practice Address - Street 1:532 WEBB BLVD
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2042
Practice Address - Country:US
Practice Address - Phone:252-447-7088
Practice Address - Fax:252-447-2752
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24793207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
59920OtherBLUE CROSS
NC8959920Medicaid
NC208938FOtherMEDICARE PTAN
NC208938FOtherMEDICARE PTAN
NC8959920Medicaid