Healthcare Provider Details

I. General information

NPI: 1740897024
Provider Name (Legal Business Name): EOIN MORIARTY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 FLORENCE ST
CHESTNUT HILL MA
02467-2641
US

IV. Provider business mailing address

188 FLORENCE ST
CHESTNUT HILL MA
02467-2641
US

V. Phone/Fax

Practice location:
  • Phone: 781-332-4135
  • Fax:
Mailing address:
  • Phone: 781-332-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA7791
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: