Provider Demographics
NPI:1871599282
Name:MOORE, TERESA AF (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:AF
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:PO BOX 927
Mailing Address - Street 2:5 E ALVON ROAD, SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5051
Practice Address - Street 1:312 KING STREET
Practice Address - Street 2:
Practice Address - City:KEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23947-4540
Practice Address - Country:US
Practice Address - Phone:434-736-8801
Practice Address - Fax:434-736-0292
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10026074OtherOPTIMA/SENTARA
VA61459601OtherBLACK LUNG/FECA
VA6774742OtherCIGNA
VA345650OtherANTHEM
VA5116589OtherAETNA
VA5625351Medicaid
VA1871599282Medicaid
VA2605469OtherAETNA
VA453599OtherANTHEM
VA00X677C14Medicare PIN
VA61459601OtherBLACK LUNG/FECA
VAP00623318Medicare PIN
G59588Medicare UPIN