Provider Demographics
NPI:1316269285
Name:MOREAU, MICHEL GUY (MD, ND)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:GUY
Last Name:MOREAU
Suffix:
Gender:M
Credentials:MD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 FIRST COLONIAL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3070
Mailing Address - Country:US
Mailing Address - Phone:757-792-7150
Mailing Address - Fax:757-707-8873
Practice Address - Street 1:1004 FIRST COLONIAL RD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3070
Practice Address - Country:US
Practice Address - Phone:757-792-7150
Practice Address - Fax:757-707-8873
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0990119265175F00000X
VA0101266902208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No175F00000XOther Service ProvidersNaturopath