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NPI Code Detail

MEDICARE: DR. JOHN T MOORE M.D.

MEDICARE: DR. JOHN T MOORE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician26099CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1026099OTHERCTSTATE MEDICAL LICENSE

General Provider Information

NPI Number : 1578626214
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN T MOORE M.D.
Provider Business Mailing Address
First Line : 40 CROSS ST
Second Line : SUITE 210
City : NORWALK
State : CT
Zip : 06851-4647
Country : US
Telephone Number : 203-846-2004
Fax Number : 203-845-2166
Provider Business Practice Location Address
First Line : 127 KINGS HWY N
Second Line :
City : WESTPORT
State : CT
Zip : 06880-2422
Country : US
Telephone Number : 203-846-2004
Fax Number : 203-845-2166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2006
Last Update Date : 01/31/2022

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