Provider Demographics
NPI:1003896036
Name:MOYER, STEPHEN D (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:MOYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2549
Mailing Address - Country:US
Mailing Address - Phone:603-577-4000
Mailing Address - Fax:603-577-4019
Practice Address - Street 1:589 W HOLLIS ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1310
Practice Address - Country:US
Practice Address - Phone:603-577-4000
Practice Address - Fax:603-577-4019
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040186207NS0135X
NH13915207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4394277Medicaid
CT070000442Medicare ID - Type Unspecified
CTH55057Medicare UPIN
NH000634901Medicare PIN