Provider Demographics
NPI:1124017660
Name:MOREAU, CHRISTINA L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:MOREAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843013
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3013
Mailing Address - Country:US
Mailing Address - Phone:866-898-7138
Mailing Address - Fax:616-975-9827
Practice Address - Street 1:114 WHITWELL ST
Practice Address - Street 2:ATTN EMERGENCY DEPT
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1870
Practice Address - Country:US
Practice Address - Phone:617-376-5549
Practice Address - Fax:617-376-5553
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA154085207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA#771587OtherTUFTS
MAJ17671OtherBCBS
MA000000005223OtherBMC HEALTHNET
MA3167887Medicaid
MAAA101473OtherPILGRIM HEALTH
MA771587OtherTUFTS
MA71888OtherHPHC
MAA2256201Medicare PIN
MA000000005223OtherBMC HEALTHNET
MA771587OtherTUFTS
MAA22562Medicare ID - Type Unspecified