1154633782 NPI number — PATRICIA SELIGA MOORE DC

Table of content: PATRICIA SELIGA MOORE DC (NPI 1154633782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154633782 NPI number — PATRICIA SELIGA MOORE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELIGA MOORE
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154633782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 WILLARD ST
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-471-4491
Provider Business Mailing Address Fax Number:
617-984-0636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1095 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02703-7944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-761-9000
Provider Business Practice Location Address Fax Number:
508-761-9111
Provider Enumeration Date:
07/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2067 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)