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General NPI Number Information
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NPI Number | 1639066459
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Entity Type | Organization
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Legal Business Name | MOORE WELLNESS CORP.
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 1661 WORCESTER RD STE 101
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City | FRAMINGHAM
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State | MA
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Zip | 01701-5401
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Country | US
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Telephone | 781-254-8755
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Fax |
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Provider Business Mailing Address
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Address Line | 63 DEERFOOT RD
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City | SOUTHBOROUGH
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State | MA
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Zip | 01772-1524
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Country | US
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Telephone | 781-254-8755
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL DAVID MOORE
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Credential |
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Telephone | 781-254-8755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WN1003X
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Taxonomy Name | Nutrition Support Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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