Provider Demographics
NPI:1962445114
Name:MOORE, BARBARA JEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JEANNE
Last Name: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 1:77 CUSHING RD
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1735
Mailing Address - Country:US
Mailing Address - Phone:781-383-3575
Mailing Address - Fax:781-383-3575
Practice Address - Street 1:77 CUSHING RD
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1735
Practice Address - Country:US
Practice Address - Phone:781-383-3575
Practice Address - Fax:781-383-3575
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56386208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3048519Medicaid
MA56386OtherMA MEDICAL LICENSE NUMBER
MA3048519Medicaid
MAM11528Medicare ID - Type Unspecified