Provider Demographics
NPI:1649384793
Name:MOORE, STEPHEN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-2297
Mailing Address - Fax:413-528-2572
Practice Address - Street 1:140 WEST AVE
Practice Address - Street 2:
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-528-2297
Practice Address - Fax:413-528-2572
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10035727OtherCDPHP
546172OtherAETNA US HEALTHCARE
703730OtherCONNECTICARE
MA9724273Medicaid
000000023150OtherBOSTON MEDICAL CENTER HEA
773834OtherTUFTS
9724273OtherMASS HEALTH
9762698003OtherCEGNA HEALTHCARE
14570OtherHEALTH NEW ENGLAND
151131OtherHARVARD
175300OtherMVP
P811505OtherOXFORD
B73517Medicare UPIN
546172OtherAETNA US HEALTHCARE