Glenndale Moore (NPI# 1164485033, PAC ID# 1052441581) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CARDIOVASCULAR DISEASE (CARDIOLOGY).
| Nation Provider ID (NPI) | 1164485033 |
| PAC ID by PECOS | 1052441581 |
| Professional Enrollment ID | I20100610000252 |
| Full Name | Glenndale Moore |
| Address |
2949 New Bern Ave Suite 112a Raleigh NC 27610-1248 |
| Phone Number | 9192313614 |
| Gender | M |
| Medical School | BOWMAN GRAY SCHOOL OF MEDICINE OF WAKE FOREST UNIVERSITY |
| Graduation Year | 1979 |
| Primary Specialty | CARDIOVASCULAR DISEASE (CARDIOLOGY) |
| Secondary Specialties | INTERNAL MEDICINE |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 340069 | WAKEMED, RALEIGH CAMPUS |
| Address | Phone | Organization |
|---|---|---|
| 2949 New Bern Ave, Suite 112a, Raleigh, NC 27610-1248 | 9192313614 |
| Street Address |
2949 NEW BERN AVE SUITE 112A |
| City | RALEIGH |
| State | NC |
| Zip | 27610-1248 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kenneth Banks | Family Practice | 2949 New Bern Ave, 112a, Raleigh, NC 27610-1248 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael C Watson Jr. | Family Medicine | Wakemed Specialists Group, LLC | 2101 Garner Rd, Raleigh, NC 27610-0114 |
| Shelby M Shirley | Nurse Practitioner | Wakemed Specialists Group, LLC | 2101 Garner Rd, Raleigh, NC 27610-0114 |
| Kurt J Ehlert | Orthopedic Surgery | Wakemed Specialists Group, LLC | 3009 New Bern Ave, Raleigh, NC 27610-1214 |
| Jennifer Clavier Desilver | Physical Therapy | Wakemed Specialists Group, LLC | 3009 New Bern Ave, Raleigh, NC 27610-1214 |
| Michelle Stiles Deans | Physician Assistant | Wake Specialty Physicians LLC | 3009 New Bern Ave, Raleigh, NC 27610-1214 |
| Sharyn R Marcisak | Occupational Therapy | Wakemed Specialists Group, LLC | 3009 New Bern Ave, Raleigh, NC 27610-1214 |
| Jonathan D Chappell | Orthopedic Surgery | Wakemed Specialists Group, LLC | 3009 New Bern Ave, Raleigh, NC 27610-1214 |
| Luke William Hudson | Physical Therapy | Wakemed Specialists Group, LLC | 3009 New Bern Ave, Raleigh, NC 27610-1214 |
| Megan Elizabeth Miller | Nurse Practitioner | Wakemed Specialists Group, LLC | 3009 New Bern Ave, Raleigh, NC 27610-1214 |
| William Giles | Physical Therapy | Wakemed Specialists Group, LLC | 3009 New Bern Ave, Raleigh, NC 27610-1214 |
| Find all physicians in zip 27610 | |||
| City | RALEIGH |
| Zip Code | 27610 |
| Specialty | CARDIOVASCULAR DISEASE (CARDIOLOGY) |
| City + Specialty | RALEIGH + CARDIOVASCULAR DISEASE (CARDIOLOGY) |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.