Provider Demographics
NPI:1033206669
Name:MARIO F MORETTI MD PC
Entity Type:Organization
Organization Name:MARIO F MORETTI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:MORETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-757-4135
Mailing Address - Street 1:12 TATUM RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3751
Mailing Address - Country:US
Mailing Address - Phone:508-757-4135
Mailing Address - Fax:508-865-1109
Practice Address - Street 1:12 TATUM RD
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3751
Practice Address - Country:US
Practice Address - Phone:508-757-4135
Practice Address - Fax:508-865-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT02607OtherBLUE SHIELD
MA2084708Medicaid
MA2084708Medicaid
MAA67855Medicare UPIN