Active NPI
Patricia M Moore, MD
- Neurology Physician
- Salisbury, NC
National Provider Identifier
1003195355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 22019
- Practice address
- 1910 Jake Alexander Blvd W Ste 102
Salisbury, NC 28147 - Phone
- (704) 637-1779
- Fax
- (704) 637-1121
- NPI assigned
- Aug 4, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 22019 | NC | Primary |
| Neurology Physician | 2084N0400X | MD066685L | PA | |
| Neurology Physician | 2084N0400X | 0101252879 | VA |
Addresses
Primary practice location
1910 Jake Alexander Blvd W Ste 102
Salisbury, NC 28147
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 637-1779
Other practice location 1
400 Sentara Cir
Suite 105
Williamsburg, VA 23188-5716
Phone (757) 984-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1830438 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22019 | NC | MD | Pharmacist |
| 0101252879 | VA | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533772800000",
"number": "1003195355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60447",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600447",
"telephone_number": "704-637-1779",
"fax_number": "704-637-1121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 JAKE ALEXANDER BLVD W STE 102",
"city": "SALISBURY",
"state": "NC",
"postal_code": "28147",
"telephone_number": "704-637-1779",
"fax_number": "704-637-1121"
}
],
"practiceLocations": [
{
"address_1": "400 Sentara Cir",
"address_2": "SUITE 105",
"address_purpose": "LOCATION",
"city": "Williamsburg",
"state": "VA",
"postal_code": "231885716",
"country_code": "US",
"telephone_number": "757-984-8200",
"fax_number": "757-903-4672",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORE",
"first_name": "PATRICIA",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-04",
"last_updated": "2018-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NC",
"license": "22019",
"primary": true
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "PA",
"license": "MD066685L",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "VA",
"license": "0101252879",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1830438",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salisbury, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.