Moore, Clen Damon

Moore, Clen Damon is an individual health care provider with primary practice located at 46440 Benedict Dr Ste 207, Sterling VA 20164-6602. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Moore, Clen Damon can be contacted via phone (703) 444-2100.

Contact Information

Primary practice address
46440 Benedict Dr Ste 207 Sterling VA 20164-6602
Phone: (703) 444-2100
Fax: (703) 444-0386
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 0101056399 Virginia

Profile Details

NPI number 1710982640
LBN Legal business name Moore, Clen Damon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Mar 29th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710982640 NPPES
Virginia MEDICAID 1710982640

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