Provider Demographics
NPI:1700834256
Name:QUINIT MOORE, RUBY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:RUBY LYNN
Middle Name:
Last Name:QUINIT MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MARTIN TER
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2708
Mailing Address - Country:US
Mailing Address - Phone:860-633-9769
Mailing Address - Fax:
Practice Address - Street 1:1703 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1133
Practice Address - Country:US
Practice Address - Phone:860-456-7252
Practice Address - Fax:860-456-2278
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7611005Medicaid
CT7611005Medicaid