Healthcare Provider Details

I. General information

NPI: 1689827990
Provider Name (Legal Business Name): MARTHA C MOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA CHRISTINE MOE MD

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POWEL AVENUE
NEWPORT RI
02840
US

IV. Provider business mailing address

12303 NE 130TH LN STE 450
KIRKLAND WA
98034-3032
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-5556
  • Fax:
Mailing address:
  • Phone: 425-899-5000
  • Fax: 425-899-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD18398
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00048423
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: