MEDICARE: PAMELA A. 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
1	207P00000X	Emergency Medicine Physician	032427	CT
2	207Q00000X	Family Medicine Physician	032427	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00030315	OTHER		RAILROAD

General Provider Information

NPI Number	:	1598739369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA A. MOORE M.D.

Provider Business Mailing Address
First Line	:	263 FARMINGTON AVE
Second Line	:	PROVIDER ENROLLMENT
City	:	FARMINGTON
State	:	CT
Zip	:	06030-2212
Country	:	US
Telephone Number	:	860-679-7503
Fax Number	:	860-679-1610

Provider Business Practice Location Address
First Line	:	1 ROYCE CIR
Second Line	:	SUITE 104
City	:	STORRS
State	:	CT
Zip	:	06268-2260
Country	:	US
Telephone Number	:	860-487-9200
Fax Number	:	860-487-9222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	09/28/2022

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