Provider Demographics
NPI:1558437244
Name:MOORE, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 CORDAGE PARK CIR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7318
Mailing Address - Country:US
Mailing Address - Phone:508-747-1443
Mailing Address - Fax:508-830-6850
Practice Address - Street 1:10 CORDAGE PARK CIR
Practice Address - Street 2:SUITE 211
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7318
Practice Address - Country:US
Practice Address - Phone:508-747-1443
Practice Address - Fax:508-830-6850
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55534207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3056694Medicaid
MA3056694Medicaid
MAJ04175Medicare PIN