Healthcare Provider Details

I. General information

NPI: 1316936867
Provider Name (Legal Business Name): DAVID W MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 WORCESTER RD
FRAMINGHAM MA
01702-5255
US

IV. Provider business mailing address

460 TOTTEN POND RD C/O MZI
WALTHAM MA
02451-1991
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-2550
  • Fax: 508-820-9844
Mailing address:
  • Phone: 781-890-9933
  • Fax: 781-890-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29318
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: