Jacqueline Moore (NPI# 1295017473, PAC ID# 8921273798) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1295017473 |
| PAC ID by PECOS | 8921273798 |
| Professional Enrollment ID | I20111206000204 |
| Full Name | Jacqueline Moore |
| Organization Legal Name | SOUTH CHARLESTON DERMATOLOGY PLLC |
| Address |
4815 Kanawha Ave Sw South Charleston WV 25309-1207 |
| Phone Number | 3047684567 |
| Gender | F |
| Graduation Year | 2011 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 1456519610 |
| Number of Group Practice Members | 4 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 | 3047684567 | SOUTH CHARLESTON DERMATOLOGY PLLC |
| Organization Legal Name | SOUTH CHARLESTON DERMATOLOGY PLLC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michelle Leigh Endicott | Dermatology | South Charleston Dermatology Pllc | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 |
| Todd V Kreitzer | Dermatology | South Charleston Dermatology Pllc | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 |
| Anthony B Knell | Physician Assistant | South Charleston Dermatology Pllc | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 |
| Street Address |
4815 KANAWHA AVE SW |
| City | SOUTH CHARLESTON |
| State | WV |
| Zip | 25309-1207 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michelle Leigh Endicott | Dermatology | South Charleston Dermatology Pllc | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 |
| Todd V Kreitzer | Dermatology | South Charleston Dermatology Pllc | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 |
| Anthony B Knell | Physician Assistant | South Charleston Dermatology Pllc | 4815 Kanawha Ave Sw, South Charleston, WV 25309-1207 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jeremy Dale Walker | Nurse Practitioner | Ths Physician Partners Inc | 506 Chestnut St, South Charleston, WV 25309-1204 |
| Michael S Dewitt | Family Medicine | Ths Physician Partners Inc | 506 Chestnut St, South Charleston, WV 25309-1204 |
| Amy Marie Combs | Physician Assistant | Ths Physician Partners Inc | 506 Chestnut St, South Charleston, WV 25309-1204 |
| Gregory Thomas Lagos | Dermatology | Center for Dermatology and Skin Care, Inc. | 607 Chestnut St, South Charleston, WV 25309-1205 |
| Megan C Evans | Physician Assistant | Center for Dermatology and Skin Care, Inc. | 607 Chestnut St, South Charleston, WV 25309-1205 |
| Derek L. Ramsey | Physician Assistant | Center for Dermatology and Skin Care, Inc. | 607 Chestnut St, South Charleston, WV 25309-1205 |
| Randi Linn Dillon | Physician Assistant | Center for Dermatology and Skin Care, Inc. | 607 Chestnut St, South Charleston, WV 25309-1205 |
| Bernard Joseph Luby | Obstetrics/gynecology | 624 Chestnut St, South Charleston, WV 25309-1241 | |
| Bruce Fredric Haupt | Orthopedic Surgery | Ths Physician Partners Inc | 610 Chestnut St, South Charleston, WV 25309-1251 |
| Freddie D Persinger | Orthopedic Surgery | Ths Physician Partners Inc | 610 Chestnut St, South Charleston, WV 25309-1251 |
| Find all physicians in zip 25309 | |||
| City | SOUTH CHARLESTON |
| Zip Code | 25309 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | SOUTH CHARLESTON + PHYSICIAN ASSISTANT |
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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.