Healthcare Provider Details

I. General information

NPI: 1154247922
Provider Name (Legal Business Name): BRYCE MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

IV. Provider business mailing address

197 STILL RIVER RD
HARVARD MA
01451-1507
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6000
  • Fax:
Mailing address:
  • Phone: 434-849-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2391605
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: