Provider Demographics
NPI:1558408245
Name:MOORE, BETH ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ALLEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 THEALL RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1404
Mailing Address - Country:US
Mailing Address - Phone:914-848-8950
Mailing Address - Fax:914-848-8951
Practice Address - Street 1:1 THEALL RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1404
Practice Address - Country:US
Practice Address - Phone:914-848-8950
Practice Address - Fax:914-848-8951
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY205094207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG86934Medicare UPIN
CT42C721Medicare ID - Type Unspecified