Provider Demographics
NPI:1760463533
Name:MOFFATT, PATRICIA H (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:H
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 BOSTON MEDICAL CTR PL
Mailing Address - Street 2:DIVISION OF PEDIATRICS DOWLING 3 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2908
Mailing Address - Country:US
Mailing Address - Phone:617-414-5170
Mailing Address - Fax:617-414-3803
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:CHILD HEALTH FOUNDATION OF BOSTON DOWLING 3 SOUTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-5170
Practice Address - Fax:617-414-3803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA32647208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2019833Medicaid
MA2019833Medicaid
E02006Medicare UPIN