Glen L Moore, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

0101044198 Issued in VA

Practice address

113 Gainsborough SQ
Ste 400
Chesapeake, VA 23320-1713

Phone

(757) 842-4499

Fax

(757) 842-1447

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369699200000",
    "number": "1265533046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 GAINSBOROUGH SQ",
            "address_2": "STE 400",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233201713",
            "telephone_number": "757-842-4499",
            "fax_number": "757-842-1447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 GAINSBOROUGH SQ",
            "address_2": "STE 400",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233201713",
            "telephone_number": "757-842-4499",
            "fax_number": "757-842-1447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "GLEN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2013-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101044198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Montes
• May Dimabuyu Monzon, LPT
• Moore Headspace Parking PLLC (Moore HealthCare PLLC)
• Crystal Moore-Maxwell, MD/PHD
• Elizabeth Zoey Moore, MS R.D.N.
• Jordon K Moore, PT, DPT
• Karen Moore, FNP
• Meredith Ann Martin Moore, ED.S.
• Sonya Susan Moore, LCSW
• Irene Therese Moorecooper

• Surgery Physician in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.