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General NPI Number Information
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NPI Number | 1144316902
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Entity Type | Individual
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Provider Name | CARLOS MORENO MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 825 WASHINGTON STREET SUITE #300
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City | NORWOOD
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State | MA
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Zip | 02062
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Country | US
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Telephone | 781-769-0552
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Fax | 781-255-9819
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Provider Business Mailing Address
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Address Line | 128 CARNEGIE ROW STE 106
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City | NORWOOD
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State | MA
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Zip | 02062-5162
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Country | US
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Telephone | 781-769-0552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 60414
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License Number State | MA
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