1881700268 NPI number — STEPHEN MOORE MD PC

Table of content: (NPI 1881700268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881700268 NPI number — STEPHEN MOORE MD PC

Organization/Personal Information

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

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:
1881700268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
01230-1823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-2297
Provider Business Mailing Address Fax Number:

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:
01230-1823
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:
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT OPHTHALMOLOGIST
Authorized Official Telephone Number:
413-528-2297

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: 703730 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 151131 . This is a "HARVARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 773834 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P811505 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9762698003 . This is a "CIGNA 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: 175300 . This is a "MVP" 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: 9724273 . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000023150 . This is a "BOSTON MED CTR HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9724273 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M19129 . This is a "GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: C18048 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10035727 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".




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