Provider Demographics
NPI:1578626214
Name:MOORE, JOHN T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:MOORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:40 CROSS ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4647
Mailing Address - Country:US
Mailing Address - Phone:203-846-2004
Mailing Address - Fax:203-845-2166
Practice Address - Street 1:127 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2422
Practice Address - Country:US
Practice Address - Phone:203-846-2004
Practice Address - Fax:203-845-2166
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2022-01-31
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Provider Licenses
StateLicense IDTaxonomies
CT260992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT026099OtherSTATE MEDICAL LICENSE