Active NPI
Clen Damon Moore, MD
- Pediatrics Physician
- Sterling, VA
National Provider Identifier
1710982640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 0101056399
- Practice address
- 46440 Benedict Dr
Ste 207
Sterling, VA 20164-6602 - Phone
- (703) 444-2100
- Fax
- (703) 444-0386
- NPI assigned
- Jun 16, 2005
- Last updated
- Mar 29, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0101056399 | VA | Primary |
Addresses
Primary practice location
46440 Benedict Dr
Ste 207
Sterling, VA 20164-6602
Mailing address
PO Box 17334
Baltimore, MD 21297-1334
Phone (703) 443-6717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710982640 | Medicaid | VA |
Other names 1
- C Damon Moore
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101056399 | VA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Loudoun Medical Group, PC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- clen.moore@lmg1.eclinicaldirectplus.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Frederick Health Hospital
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301356800000",
"number": "1710982640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 17334",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212971334",
"telephone_number": "703-443-6717",
"fax_number": "703-443-8643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46440 BENEDICT DR",
"address_2": "STE 207",
"city": "STERLING",
"state": "VA",
"postal_code": "201646602",
"telephone_number": "703-444-2100",
"fax_number": "703-444-0386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "CLEN",
"middle_name": "DAMON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2011-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "VA",
"license": "0101056399",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710982640",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "C",
"last_name": "MOORE",
"middle_name": "DAMON",
"credential": "MD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Sterling, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.