Mark G. Moore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3260 Issued in GA

Practice address

700 24TH St
Fort Lee, VA 23801-1716

Phone

(804) 734-9867

Fax

(877) 874-1008

NPI assigned

Aug 31, 2006

Last updated

Jun 13, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Internal Medicine Specialist, PA

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1326079567
  NPD (past)
• Iredell Memorial Hospital, Incorporated

  • General Acute Care Hospital
  • Statesville, NC
  • NPI 1417944224
  NPD (past)
• Piedmont Emergency Medical Associates, PA

  • Emergency Medicine Physician
  • Charlotte, NC
  • NPI 1801822523
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1861504326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 24TH ST",
            "city": "FORT LEE",
            "state": "VA",
            "postal_code": "238011716",
            "telephone_number": "804-734-9867",
            "fax_number": "877-874-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 24TH ST",
            "city": "FORT LEE",
            "state": "VA",
            "postal_code": "238011716",
            "telephone_number": "804-734-9867",
            "fax_number": "877-874-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARK",
        "middle_name": "G.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "3260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Mourilhe McEntire, MD
• Rhonda S McGuire
• Pamela Annette McPhearson, ACNP, CCNS, CCRN
• Kathleen Bernice Mitchell, CPNP
• David Robert Moody, PH.D.
• Michael Anthony Morris
• Mason Mullaney, DMD
• Celia Renee Murray, RN
• Prakash Nathu, M.D.
• National Vision, Inc. (Vista Optical in Select Military Exchanges)

• Physician Assistant in Fort Lee, VA
• Providers in Fort Lee, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; 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.