Provider Demographics
NPI:1821434309
Name:MOYER, MATTHEW (APRN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MOYER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2322
Mailing Address - Country:US
Mailing Address - Phone:860-538-3574
Mailing Address - Fax:
Practice Address - Street 1:6 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416
Practice Address - Country:US
Practice Address - Phone:860-538-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10.101687163WM0705X
CTTBD207RG0300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine