Basic Information
| Provider Information | |||||||||
| NPI: | 1740201490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOYER | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | KELLER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226012888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405355100 | ||||||||
| FaxNumber: | 5405360235 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | LURAY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228351000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407438018 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101261803 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 17782490001 | 05 | PA | MEDICAID | 321845 | 01 | PA | HEALTH AMERICA | OTHER | 930083979 | 01 | PA | RAILROAD MEDICARE | OTHER | 232809429 | 01 | PA | TRICARE | OTHER | 0838087 | 01 | PA | BLUE SHIELD | OTHER |