Provider Demographics
NPI:1962685396
Name:CECILIA G. MOORE DPM LLC
Entity Type:Organization
Organization Name:CECILIA G. MOORE DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-945-8720
Mailing Address - Street 1:214 ORLEANS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02650-3101
Mailing Address - Country:US
Mailing Address - Phone:508-945-8720
Mailing Address - Fax:508-945-8724
Practice Address - Street 1:214 ORLEANS RD
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02650-3101
Practice Address - Country:US
Practice Address - Phone:508-945-8720
Practice Address - Fax:508-945-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2197213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77351OtherBLUE SHIELD OF MA
MAY77351OtherBLUE SHIELD OF MA