Provider Demographics
NPI:1881700268
Name:STEPHEN MOORE MD PC
Entity type:Organization
Organization Name:STEPHEN MOORE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-528-2297
Mailing Address - Street 1:140 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1823
Mailing Address - Country:US
Mailing Address - Phone:413-528-2297
Mailing Address - Fax:
Practice Address - Street 1:140 WEST AVE
Practice Address - Street 2:
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1823
Practice Address - Country:US
Practice Address - Phone:413-528-2297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
703730OtherCONNECTICARE
151131OtherHARVARD
773834OtherTUFTS
P811505OtherOXFORD
9762698003OtherCIGNA HEALTHCARE
14570OtherHEALTH NEW ENGLAND
175300OtherMVP
546172OtherAETNA US HEALTHCARE
9724273OtherMASS HEALTH
000000023150OtherBOSTON MED CTR HEALTH NET
MA9724273Medicaid
M19129OtherGROUP NUMBER
C18048OtherBLUE CROSS BLUE SHIELD
10035727OtherCDPHP
M19129OtherGROUP NUMBER
B73517Medicare UPIN