Basic Information
| Provider Information | |||||||||
| NPI: | 1013379429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROL E MOORE MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2828B MAPLEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271034138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366599440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2828B MAPLEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271034138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366599440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2016 | ||||||||
| LastUpdateDate: | 04/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3366599440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 34108 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 34108 | 01 | NC | LICENSE | OTHER |