Provider Demographics
NPI:1699112409
Name:MOORE, DENEE J (MD)
Entity type:Individual
Prefix:
First Name:DENEE
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PRESTON AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4491
Mailing Address - Country:US
Mailing Address - Phone:434-227-5624
Mailing Address - Fax:434-970-7700
Practice Address - Street 1:901 PRESTON AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4491
Practice Address - Country:US
Practice Address - Phone:434-227-5624
Practice Address - Fax:434-970-7700
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine