Provider Demographics
NPI:1700957727
Name:MOORE, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1950
Mailing Address - Country:US
Mailing Address - Phone:716-825-3601
Mailing Address - Fax:716-825-2850
Practice Address - Street 1:2943 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1950
Practice Address - Country:US
Practice Address - Phone:716-825-3601
Practice Address - Fax:716-825-2850
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124157207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5080261OtherHEALTHNOW COMMUNITY BLUE
NY00010121501OtherUNIVERA
NY2301114OtherINDEPENDENT HEALTH
NY2301114OtherINDEPENDENT HEALTH
NY5080261OtherHEALTHNOW COMMUNITY BLUE