Healthcare Provider Details

I. General information

NPI: 1932125895
Provider Name (Legal Business Name): RICHARD MOORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD STE 258
ROCHESTER NY
14620-4155
US

IV. Provider business mailing address

125 LATTIMORE RD STE 258
ROCHESTER NY
14620-4155
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-8020
  • Fax: 585-442-8039
Mailing address:
  • Phone: 585-442-8020
  • Fax: 585-442-8039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number281492
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD10060
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: