1649384793 NPI number — STEPHEN ALAN MOORE MD

Table of content: STEPHEN ALAN MOORE MD (NPI 1649384793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649384793 NPI number — STEPHEN ALAN MOORE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
STEPHEN
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1649384793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 WEST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GT BARRINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-2297
Provider Business Mailing Address Fax Number:
413-528-2572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 WEST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-528-2297
Provider Business Practice Location Address Fax Number:
413-528-2572
Provider Enumeration Date:
08/18/2006

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: 207W00000X , with the licence number:  31963 , 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)

  • Identifier: 10035727 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 546172 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 703730 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9724273 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000023150 . This is a "BOSTON MEDICAL CENTER HEA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 773834 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9724273 . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9762698003 . This is a "CEGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14570 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 151131 . This is a "HARVARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 175300 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P811505 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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