Healthcare Provider Details

I. General information

NPI: 1740261486
Provider Name (Legal Business Name): STEPHANIE A MOORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE A VRABLE M.D.

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST # 800 DEPARTMENT OF CARDIOVASCULAR MEDICINE
BOSTON MA
02114-2621
US

IV. Provider business mailing address

71 OLD PICKARD RD
CONCORD MA
01742-4723
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-9554
  • Fax:
Mailing address:
  • Phone: 617-763-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number222943
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number54742
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: