Provider Demographics
NPI:1689135287
Name:MORIARTY, KRISTEN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEE
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:LEE
Other - Last Name:MORIARTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-2147
Mailing Address - Fax:860-679-4624
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-972-2780
Practice Address - Fax:860-972-1377
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT075373207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program