Provider Demographics
NPI:1518064609
Name:MOORE, CECILIA G (DPM)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:G
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1245 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633-1889
Mailing Address - Country:US
Mailing Address - Phone:508-945-8720
Mailing Address - Fax:508-945-8724
Practice Address - Street 1:1245 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633-1889
Practice Address - Country:US
Practice Address - Phone:508-945-8720
Practice Address - Fax:508-945-8724
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2197213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA419034OtherTUFTS HEALTH PLAN
MA7648677OtherAETNA
MAY71110OtherBLUE SHEILD OF MA
MA201301115OtherUNITED HEALTH CARE
MAAA19095OtherHARVARD PILGRIM HEALTH
MA000000033550OtherBMC
MA419034OtherTUFTS HEALTH PLAN
MAAA19095OtherHARVARD PILGRIM HEALTH
MAY75133Medicare PIN