Healthcare Provider Details

I. General information

NPI: 1649384793
Provider Name (Legal Business Name): STEPHEN ALAN MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WEST AVE
GT BARRINGTON MA
01230
US

IV. Provider business mailing address

140 WEST AVE
GT BARRINGTON MA
01230
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-2297
  • Fax: 413-528-2572
Mailing address:
  • Phone: 413-528-2297
  • Fax: 413-528-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31963
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: