Healthcare Provider Details

I. General information

NPI: 1962685396
Provider Name (Legal Business Name): CECILIA G. MOORE DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 ORLEANS RD SUITE C
NORTH CHATHAM MA
02650-3101
US

IV. Provider business mailing address

214 ORLEANS RD SUITE C
NORTH CHATHAM MA
02650-3101
US

V. Phone/Fax

Practice location:
  • Phone: 508-945-8720
  • Fax: 508-945-8724
Mailing address:
  • Phone: 508-945-8720
  • Fax: 508-945-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2197
License Number StateMA

VIII. Authorized Official

Name: DR. CECILIA G MOORE
Title or Position: OWNER
Credential: D.P.M.
Phone: 508-945-8720